Basic Information
| Provider Information | |||||||||
| NPI: | 1841608239 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EHRLICH | ||||||||
| FirstName: | MARY KATHERINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 LINCOLN ST | ||||||||
| Address2: | EDWARD M. KENNEDY COMMUNITY HEALTH CENTER | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085325318 | ||||||||
| FaxNumber: | 5088538593 | ||||||||
| Practice Location | |||||||||
| Address1: | 354 WAVERLY ST | ||||||||
| Address2: | |||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017027079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082705700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2014 | ||||||||
| LastUpdateDate: | 07/29/2014 | ||||||||
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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 | 163W00000X | RN204968 | MA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.