Provider Demographics
NPI:1427007822
Name:MARCEL-SAINT-LOUIS DEMERTINE, JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:MARCEL-SAINT-LOUIS DEMERTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:HEROLD
Other - Last Name:MARCEL-ST-LOUIS DEMERTINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3415
Mailing Address - Country:US
Mailing Address - Phone:617-247-1400
Mailing Address - Fax:617-247-1411
Practice Address - Street 1:581 BOYLSTON ST
Practice Address - Street 2:800
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3608
Practice Address - Country:US
Practice Address - Phone:617-247-1400
Practice Address - Fax:617-247-1411
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76898208D00000X, 2083P0901X, 207QG0300X, 208M00000X, 207Q00000X, 207PE0004X
NY233842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3203808Medicaid
MAA30300Medicare ID - Type Unspecified
MA3203808Medicaid