Healthcare Provider Details

I. General information

NPI: 1457588162
Provider Name (Legal Business Name): KRISTEN MCCARTHY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN KAVULICH D.O.

II. Dates (important events)

Enumeration Date: 06/20/2009
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 LITTLETON RD SUITE 202
WESTFORD MA
01886-3098
US

IV. Provider business mailing address

133 LITTLETON RD SUITE 202
WESTFORD MA
01886-3098
US

V. Phone/Fax

Practice location:
  • Phone: 978-577-1946
  • Fax: 978-692-4716
Mailing address:
  • Phone: 978-577-1946
  • Fax: 978-692-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number241703
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: