Provider Demographics
NPI:1245204528
Name:CATHY L VANDENHEUVEL, MD, PC
Entity Type:Organization
Organization Name:CATHY L VANDENHEUVEL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANDENHEUVEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-953-3211
Mailing Address - Street 1:1223 BEACON ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5302
Mailing Address - Country:US
Mailing Address - Phone:617-879-1544
Mailing Address - Fax:617-608-1113
Practice Address - Street 1:1223 BEACON ST
Practice Address - Street 2:SUITE E
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5302
Practice Address - Country:US
Practice Address - Phone:617-879-1544
Practice Address - Fax:617-608-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209071261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0165964Medicaid
MA0102535OtherUNITED HEALTHCARE
MA209071OtherTUFTS
MA691784OtherHCHP
MA2725409OtherAETNA
MAJ23712OtherBCBS
MA209071OtherTUFTS
MA=========OtherONEHEALTH
MA=========OtherUNICARE
MAJ23712OtherBCBS
MA=========OtherCIGNA
MA=========OtherHUMANA
MA=========OtherUNICARE
MA=========OtherONEHEALTH