Healthcare Provider Details

I. General information

NPI: 1780668962
Provider Name (Legal Business Name): KATHLEEN M CLEARY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 LEOMINSTER RD
STERLING MA
01564-2148
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-0001
US

V. Phone/Fax

Practice location:
  • Phone: 978-422-6900
  • Fax: 978-422-7561
Mailing address:
  • Phone: 800-225-8885
  • Fax: 508-334-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number74880
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: