Provider Demographics
NPI:1548485741
Name:CHISHOLM, KARA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:ANNE
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-421-6540
Mailing Address - Fax:
Practice Address - Street 1:2 ESSEX CENTER DR
Practice Address - Street 2:NEUROLOGY DEPT
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2902
Practice Address - Country:US
Practice Address - Phone:978-977-4110
Practice Address - Fax:978-977-4149
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2011-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2223332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110082873AMedicaid
MA001271201Medicare PIN