1558781260 NPI number — DR. KATELYN C DANNHEIM DREW MD

Table of content: DR. KATELYN C DANNHEIM DREW MD (NPI 1558781260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558781260 NPI number — DR. KATELYN C DANNHEIM DREW MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANNHEIM DREW
Provider First Name:
KATELYN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DANNHEIM
Provider Other First Name:
KATELYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1558781260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 FRUIT ST
Provider Second Line Business Mailing Address:
DEPARTMENT OF PATHOLOGY, WARREN BUILDING 225
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02114-2696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-643-0800
Provider Business Mailing Address Fax Number:
617-726-7474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 FRUIT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-643-0800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZH0000X , with the licence number:  269758 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0101X , with the licence number: MD16702 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0213X , with the licence number: 269758 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0101X , with the licence number: 269758 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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