Basic Information
Provider Information
NPI: 1003006727
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GAMBACORTA
FirstName: KATHERINE
MiddleName: ANNE
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: WENDT
OtherFirstName: KATHERINE
OtherMiddleName: ANNE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 8 FRENCH ST
Address2:  
City: WATERTOWN
State: MA
PostalCode: 024722347
CountryCode: US
TelephoneNumber: 3303483773
FaxNumber: 4408790084
Practice Location
Address1: 4110 WARRENSVILLE CENTER RD
Address2:  
City: BEACHWOOD
State: OH
PostalCode: 441227024
CountryCode: US
TelephoneNumber: 2164916000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/30/2007
LastUpdateDate: 07/10/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X34-008985OHY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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