1518958404 NPI number — KATHY JENKINS MD

Table of content: KATHY JENKINS MD (NPI 1518958404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518958404 NPI number — KATHY JENKINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENKINS
Provider First Name:
KATHY
Provider Middle Name:
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518958404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 LONGWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02115-5724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-355-7275
Provider Business Mailing Address Fax Number:
603-893-8886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 LONGWOOD AVE
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:
02115-5724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-355-2793
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2005

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: 208000000X , with the licence number:  72081 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X , with the licence number: 72081 , 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)

  • Identifier: 3114520 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 604501 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: KJ03671 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1508016 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7613741 . This is a "MEDICAID NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: B20216801 . This is a "CIGNA MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 99085901 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 300006034 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7500149 . This is a "UNITED HEALTHCARE MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J14168 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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