Provider Demographics
NPI:1053393470
Name:NOWAK, CATHERINE M (MD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:M
Last Name:NOWAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:B
Other - Last Name:NOWAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7 JOANNE DR
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3519
Mailing Address - Country:US
Mailing Address - Phone:508-320-0782
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-1742
Practice Address - Fax:617-726-1566
Is Sole Proprietor?:No
Enumeration Date:2005-11-20
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76523208000000X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3126668Medicaid
MA3126668Medicaid
MANO J31034Medicare ID - Type Unspecified