Provider Demographics
NPI:1154323251
Name:BOULANGER, PAULA (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:BOULANGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6278
Mailing Address - Country:US
Mailing Address - Phone:978-521-3230
Mailing Address - Fax:978-521-3256
Practice Address - Street 1:1 PARKWAY
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6278
Practice Address - Country:US
Practice Address - Phone:978-521-3230
Practice Address - Fax:978-521-3256
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA73272208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
678837OtherHEALTHSOURCE
MA1154323251OtherAETNA HMO
NH30009867OtherNEW HAMPSHIRE MEDICAID
MA1154323251OtherFALLON COMMUNITY HEALTH PLAN
977342OtherNETWORK HEALTH
0016275OtherNEIGHBORHOOD HEALTH PLAN
MA073272OtherTUFTS HEALTH PLAN
MAJ31637OtherBLUE CROSS BLUE SHIELD
MA110056616AMedicaid
MA201427OtherHARVARD PILGRIM HEALTHCAR
5327624OtherCIGNA
MA5349131OtherAETNA NON HMO
NHG17620OtherANTHEM BLUE CROSS
MAA2077101Medicare PIN
MA5349131OtherAETNA NON HMO