Provider Demographics
NPI:1114129053
Name:MATTA, KATHERINE DIANE (MD)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:DIANE
Last Name:MATTA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:DIANE
Other - Last Name:SCHAFBUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1180 BEACON ST STE 6D
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3806
Mailing Address - Country:US
Mailing Address - Phone:617-232-0440
Mailing Address - Fax:617-232-8444
Practice Address - Street 1:1180 BEACON ST STE 6D
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3806
Practice Address - Country:US
Practice Address - Phone:617-232-0440
Practice Address - Fax:617-232-8444
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA245099207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology