Provider Demographics
NPI:1477530939
Name:BOEPPLE, PAUL ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALFRED
Last Name:BOEPPLE
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:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-2909
Mailing Address - Fax:617-724-0581
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:YAW 6C PEDIATRIC ENDOCRINE ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-2909
Practice Address - Fax:617-724-0581
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52300208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ04164OtherBCBS MA
MA6186734Medicaid
MA724780OtherTUFTS HEALTH PLAN
MA6186734Medicaid
MAJ04164OtherBCBS MA