Basic Information
| Provider Information | |||||||||
| NPI: | 1346209251 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOLIFRATH | ||||||||
| FirstName: | NORMA | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 MEETING HOUSE RD | ||||||||
| Address2: | SUITE 6-8 | ||||||||
| City: | CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018242766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784549811 | ||||||||
| FaxNumber: | 9789379281 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 MEETING HOUSE RD | ||||||||
| Address2: | SUITE 6-8 | ||||||||
| City: | CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018242766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784549811 | ||||||||
| FaxNumber: | 9789379281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 211645 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 30249 | 01 | HARVARD PILGRIM | OTHER | 600626 | 01 | TUFTS HEALTH PLAN | OTHER | KONP2037 | 01 | BLUE CROSS & BLUE SHIELD | OTHER | 0325911 | 05 | MA | MEDICAID |