Basic Information
| Provider Information | |||||||||
| NPI: | 1396126801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHIAVONI | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | MGH REVERE HEALTHCARE CENTER | ||||||||
| Address2: | 300 OCEAN AVE. | ||||||||
| City: | REVERE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814856000 | ||||||||
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| Practice Location | |||||||||
| Address1: | MGH REVERE HEALTHCARE CENTER | ||||||||
| Address2: | 300 OCEAN AVE. | ||||||||
| City: | REVERE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814856000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2015 | ||||||||
| LastUpdateDate: | 04/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | L-263287 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 273303 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.