Provider Demographics
NPI:1316984941
Name:NORTHRUP, KATHLEEN O (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:O
Last Name:NORTHRUP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:26 OLD BROOK RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-5409
Mailing Address - Country:US
Mailing Address - Phone:508-845-0127
Mailing Address - Fax:
Practice Address - Street 1:14 PROSPECT ST
Practice Address - Street 2:MILFORD HOSPT.
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3003
Practice Address - Country:US
Practice Address - Phone:508-422-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209681207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0008333OtherNHP
J24479OtherBLUE CROSS BLUE SHIELD
000000021079OtherBMC HEALTHNET
930115612OtherRAILROAD MEDICARE
974918OtherNETWORK HEALTH
65368OtherFALLON
209681OtherTUFTS
MA0162914Medicaid
613214OtherHARVARD PILGRIM HEALTH CARE
MAA33488Medicare PIN