Provider Demographics
NPI:1992730816
Name:MCGOWAN, KATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:MCGOWAN
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 1:1153 CENTRE STREET
Mailing Address - Street 2:SUITE 4950
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:617-522-4943
Mailing Address - Fax:617-983-2358
Practice Address - Street 1:1153 CENTRE STREET
Practice Address - Street 2:SUITE 4950 FAULKNER HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-522-4943
Practice Address - Fax:617-983-2358
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42007207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
042007OtherTUFTS
S012305OtherCHAMPUS
0084444OtherAETNA US HEALTH
MA0120308Medicaid
C05225OtherBLUE SHIELD
6786OtherHARVARD PILGRIM
6786OtherHARVARD PILGRIM
C05225OtherBLUE SHIELD
MA0120308Medicaid