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NPI Code Detail

MEDICARE: KATHLEEN F MITCHELL M.D.

MEDICARE: KATHLEEN F MITCHELL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician58561MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1058561OTHERMATUFTS
20015140OTHERMANEIGHBORHOOD HEALTH
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4PP287OTHERMAHARVARD PILGRIM
5J06691OTHERMABLUE CROSS

General Provider Information

NPI Number : 1164402269
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN F MITCHELL M.D.
Provider Business Mailing Address
First Line : 147 MILK ST
Second Line : PROVIDER ENROLLMENT - 9TH FLOOR
City : BOSTON
State : MA
Zip : 02109-4806
Country : US
Telephone Number : 617-559-8053
Fax Number : 617-421-3487
Provider Business Practice Location Address
First Line : 485 ARSENAL ST
Second Line :
City : WATERTOWN
State : MA
Zip : 02472-5091
Country : US
Telephone Number : 617-972-5100
Fax Number : 671-972-5439
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2006
Last Update Date : 07/08/2007

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Directions to “ KATHLEEN F MITCHELL M.D.” Practice Location

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