Healthcare Provider Details

I. General information

NPI: 1043267735
Provider Name (Legal Business Name): KAREN ELLEN REDNOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 CORDAVILLE RD SUITE 185
SOUTHBOROUGH MA
01772-1838
US

IV. Provider business mailing address

162 CORDAVILLE RD STE 185 PO BOX 296
SOUTHBOROUGH MA
01772-1838
US

V. Phone/Fax

Practice location:
  • Phone: 508-229-8811
  • Fax: 508-229-0666
Mailing address:
  • Phone: 508-229-8811
  • Fax: 508-229-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number72055
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: