Provider Demographics
NPI:1255307179
Name:KAESS, H WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:H
Middle Name:WALTER
Last Name:KAESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3007
Mailing Address - Country:US
Mailing Address - Phone:508-775-1984
Mailing Address - Fax:508-790-1897
Practice Address - Street 1:100 CAMP ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3007
Practice Address - Country:US
Practice Address - Phone:508-775-1984
Practice Address - Fax:508-790-1897
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44260208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA044260OtherTUFTS HEALTH PLAN
MA801557OtherHARVARD PILGRIM HEALTH
MA000000029653OtherBOSTON MEDICAL CENTER H P
MA30423OtherCHILDRENS MED SEC PLAN
MAL15121OtherBCBS
MA2070502Medicaid
MAL15121Medicare ID - Type Unspecified
A59770Medicare UPIN