1336136159 NPI number — DR. KATHRYN L OLSON M.D.

Table of content: DR. KATHRYN L OLSON M.D. (NPI 1336136159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336136159 NPI number — DR. KATHRYN L OLSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSON
Provider First Name:
KATHRYN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1336136159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 BARTLETT ST
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01852-1334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-452-1331
Provider Business Mailing Address Fax Number:
978-452-8331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 BARTLETT ST
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01852-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-452-1331
Provider Business Practice Location Address Fax Number:
978-452-8331
Provider Enumeration Date:
10/06/2005

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: 174400000X , with the licence number:  75177 , 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: 0003666 . This is a "NHP-MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 20342 . This is a "FALLON COMMUNITY HP" identifier . This identifiers is of the category "OTHER".
  • Identifier: J30075 . This is a "BCBS-MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9738720 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7024906 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3312 . This is a "HEALTHSOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 075177 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3736202 . This is a "AETNA/US HEALTHCARE HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5137245 . This is a "AETNA/US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 130020 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 979922 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".




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