Basic Information
| Provider Information | |||||||||
| NPI: | 1407804594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'DONNELL | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 PARK ST | ||||||||
| Address2: | APT. 1 | ||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024466338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173556363 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 LONGWOOD AVENUE | ||||||||
| Address2: | CHILDRENS HOSPITAL | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173556363 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 227313 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.