Fantasia, Kathryn L.

Fantasia, Kathryn L. is an individual health care provider with primary practice located at 732 Harrison Ave, Fl 2 Preston Bldg, Boston MA 02118-2309. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism. Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism is her primary health care specialty. Fantasia, Kathryn L. can be contacted via phone (617) 638-7470.

Contact Information

Primary practice address
732 Harrison Ave, Fl 2 Preston Bldg Boston MA 02118-2309
Phone: (617) 638-7470
Fax: (617) 638-7449
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 265826 Massachusetts
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X 265826 Massachusetts

Profile Details

NPI number 1023453628
LBN Legal business name Fantasia, Kathryn L.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 8th, 2013
Last updated Feb 1st, 2024 - about 10 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023453628 NPPES
Massachusetts MEDICAID 110111927A

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