Provider Demographics
NPI:1124046644
Name:ACKERMAN, KATHRYN E (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:ACKERMAN
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 1:20 GUEST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2040
Mailing Address - Country:US
Mailing Address - Phone:617-362-6450
Mailing Address - Fax:617-362-6460
Practice Address - Street 1:20 GUEST ST STE 200
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2040
Practice Address - Country:US
Practice Address - Phone:617-362-6450
Practice Address - Fax:617-362-6460
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228833207RS0010X, 207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine