Healthcare Provider Details

I. General information

NPI: 1326036880
Provider Name (Legal Business Name): KATHLEEN G WARE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 PLEASANT ST
WEST BRIDGEWATER MA
02379-1506
US

IV. Provider business mailing address

22 PLEASANT ST
WEST BRIDGEWATER MA
02379-1506
US

V. Phone/Fax

Practice location:
  • Phone: 508-588-6200
  • Fax: 508-588-6211
Mailing address:
  • Phone: 508-588-6200
  • Fax: 508-588-6211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number152894
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: