Provider Demographics
NPI:1194777177
Name:MEADE, KATHLEEN L (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:MEADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9421
Mailing Address - Country:US
Mailing Address - Phone:413-467-9319
Mailing Address - Fax:413-540-9380
Practice Address - Street 1:84 WILLIMANSETT ST
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-3062
Practice Address - Country:US
Practice Address - Phone:413-534-1665
Practice Address - Fax:413-540-9380
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD789982OtherCONNECTICARE
MA078998OtherTUFTS HEALTH PLAN
MA3133541Medicaid
MA078998OtherTUFTS HEALTH PLAN
MD789982OtherCONNECTICARE