Provider Demographics
NPI:1053775858
Name:DOONAN, KATIE L (DO)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:L
Last Name:DOONAN
Suffix:
Gender:
Credentials:DO
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Mailing Address - Street 1:795 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1733
Mailing Address - Country:US
Mailing Address - Phone:978-314-6047
Mailing Address - Fax:
Practice Address - Street 1:670 ALBANY STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2646
Practice Address - Country:US
Practice Address - Phone:617-414-4291
Practice Address - Fax:617-414-5315
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA287805207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110166745AMedicaid
NH6930520Medicaid