Provider Demographics
NPI:1215251731
Name:KINNAMAN, KAREN ANNE
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANNE
Last Name:KINNAMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EMERSON PL
Mailing Address - Street 2:APT 14N
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2252
Mailing Address - Country:US
Mailing Address - Phone:845-901-0360
Mailing Address - Fax:
Practice Address - Street 1:1 EMERSON PL
Practice Address - Street 2:APT 14N
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2252
Practice Address - Country:US
Practice Address - Phone:617-732-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253778207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program