Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 265826 | MA |
N | 111NI0900X | Internist | 265826 | MA |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 265826 | MA |
NPI | 1023453628 |
---|---|
Provider Name | Dr. Kathryn L. Fantasia |
First Address | Boston, MA 02119 |
Second Address | Boston, MA 02118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2013 |
Last Update Date | 06/04/2020 |