Provider Demographics
NPI:1215318639
Name:KENTOFFIO, KATHERINE J (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:KENTOFFIO
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:DIVISION OF CARDIOLOGY, BAKER 4
Mailing Address - Street 2:185 PILGRIM ROAD
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-667-8800
Mailing Address - Fax:
Practice Address - Street 1:CARDIOVASCULAR MEDICINE
Practice Address - Street 2:330 BROOKLINE AVE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-667-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-263482207R00000X
MA274384208M00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA274384OtherMA STATE MEDICAL LICENSE