Provider Demographics
NPI:1174571228
Name:PHANEUF, KATHERINE L (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:PHANEUF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:133 LITTLETON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3115
Mailing Address - Country:US
Mailing Address - Phone:978-577-1946
Mailing Address - Fax:978-692-4716
Practice Address - Street 1:133 LITTLETON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3115
Practice Address - Country:US
Practice Address - Phone:978-577-1946
Practice Address - Fax:978-692-4716
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA78728207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3193497Medicaid
MAJ30223OtherBCBS OF MA
MA078728OtherTUFTS
MAJ30223Medicare PIN
MA3193497Medicaid