Provider Demographics
NPI:1346312733
Name:BERTOZZI, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BERTOZZI
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 1:300 MOUNT AUBURN ST STE 419
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5665
Mailing Address - Country:US
Mailing Address - Phone:617-354-8771
Mailing Address - Fax:617-441-6393
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 419
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5600
Practice Address - Country:US
Practice Address - Phone:617-354-8771
Practice Address - Fax:617-441-6393
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55938207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ08624OtherBLUE CROSS
MA0014981OtherNEIGHBORHOOD HEALTH
MAPM989OtherHARVARD PILGRIM
MA0422095-002OtherCIGNA
MA765474OtherTUFTS HEALTH PLAN
MA3072061Medicaid
MA0422095-002OtherCIGNA
MAE09900Medicare UPIN