Healthcare Provider Details

I. General information

NPI: 1467610477
Provider Name (Legal Business Name): KATHARINE A CONNOLLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ROCK ROW STE 210
WESTBROOK ME
04092-4877
US

IV. Provider business mailing address

11 ROCK ROW STE 210
WESTBROOK ME
04092-4877
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-3446
  • Fax:
Mailing address:
  • Phone: 207-775-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD20877
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: