Individual
DR. KATHRYN L. FANTASIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
732 HARRISON AVE, FL 2, PRESTON BLDG, BOSTON, MA 02118-2309
(617) 638-7470
(617) 638-7449
Mailing address
960 MASSACHUSETTS AVENUE, FL 2, BOSTON, MA 02118-2690
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
265826
MA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
265826
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110111927A
—
MA
Enumeration date
05/08/2013
Last updated
02/01/2024
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