Basic Information
| Provider Information | |||||||||
| NPI: | 1164486148 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIAMARI | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | B. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | AGAWAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010011838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137896800 | ||||||||
| FaxNumber: | 4137895171 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | AGAWAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010011838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137896800 | ||||||||
| FaxNumber: | 4137895171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 11/28/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 71073 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 3047920 | 05 | MA | MEDICAID |