Basic Information
| Provider Information | |||||||||
| NPI: | 1447241518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YUTANGCO | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 370 FAUNCE CORNER ROAD | ||||||||
| Address2: | SOUTHCOAST PHYSICIAN SERVICES, INC. | ||||||||
| City: | NORTH DARTMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089852000 | ||||||||
| FaxNumber: | 5089852001 | ||||||||
| Practice Location | |||||||||
| Address1: | 1030 PRESIDENT AVENUE, SUITE 1001 | ||||||||
| Address2: | SOUTHCOAST PHYSICIAN SERVICES, INC. | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087303000 | ||||||||
| FaxNumber: | 5087303071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 09/15/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD10484 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 208109 | MA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 208109 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9023138 | 05 | RI | MEDICAID | 408877 | 01 | RI | BLUECHIP | OTHER | 29885-2 | 01 | RI | BC/BS | OTHER |