Provider Demographics
NPI:1437191079
Name:SHERRITT, KAREN M (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:SHERRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:
Practice Address - Street 1:291 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3628
Practice Address - Country:US
Practice Address - Phone:617-541-6515
Practice Address - Fax:617-541-6444
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA151591207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAV526OtherHARVARD PILGRIM
MA0010871OtherNEIGHBORHOOD HEALTH
MA151591OtherTUFTS
MA3168107Medicaid
MAJ17977OtherBLUE CROSS
MA151591OtherTUFTS
MAG50633Medicare UPIN