=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043277429
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLYN A CLINE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2006
-----------------------------------------------------
Last Update Date | 04/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ONE BROOKLINE PLACE SUITE 521
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02445-7277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-735-8800
-----------------------------------------------------
Fax | 617-278-9358
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ONE BROOKLINE PLACE DRS. JEFFREY KATZ AND CAROLYN CLINE
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-735-8800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 74397
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------