Basic Information
| Provider Information | |||||||||
| NPI: | 1316901127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORTUNE | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 RESEARCH PL STE 320 | ||||||||
| Address2: | |||||||||
| City: | N CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018632455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782561858 | ||||||||
| FaxNumber: | 9787887890 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 RESEARCH PL STE 320 | ||||||||
| Address2: | |||||||||
| City: | N CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018632455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782561858 | ||||||||
| FaxNumber: | 9787887890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 159413 | MA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1912179870 | 01 | MA | HEALTHNET SERVICES | OTHER | 1316901127 | 01 | MA | NETWORK HEALTH | OTHER | 1316901127 | 01 | MA | NETWORK | OTHER | 1316901127 | 01 | MA | HEALTH PLANS INC | OTHER | 1316901127 | 01 | MA | BMC HEALTH NET | OTHER | 1316901127 | 01 | MA | FALLON | OTHER | 1316901127 | 01 | MA | CIGNA | OTHER | 1316901127 | 01 | MA | AETNA | OTHER | 1316901127 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 1316901127 | 01 | MA | HEALTHNET OF CA | OTHER | 1316901127 | 01 | MA | TUFTS | OTHER | 1912179870 | 01 | MA | HEALTHY START | OTHER | 3198219 | 05 | MA | MEDICAID | AA114657 | 01 | MA | HARVARD PILGRIM | OTHER | 1316901127 | 01 | MA | CHAMPUS/TRICARE | OTHER | 1316901127 | 01 | MA | UNITED HEALTH CARE | OTHER | 1316901127 | 01 | MA | HEALTHSOURCE | OTHER | 131690127 | 01 | MA | GREAT WEST | OTHER | 1316901127 | 01 | MA | PHCS | OTHER | J21558 | 01 | MA | BCBS MA | OTHER |