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General NPI Number Information
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NPI Number | 1427056225
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Entity Type | Individual
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Provider Name | KATHLEEN HOLLY GALLIVAN MD,MPH,FACS
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Gender | Female
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 100 TRADECENTER SUITE 750
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City | WOBURN
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State | MA
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Zip | 01801-1851
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Country | US
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Telephone | 781-937-3001
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Fax | 781-305-2779
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Provider Business Mailing Address
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Address Line | 100 TRADECENTER SUITE 750
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City | WOBURN
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State | MA
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Zip | 01801-1851
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Country | US
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Telephone | 781-937-3001
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Fax | 781-305-2779
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 204711
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License Number State | MA
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