Provider Demographics
NPI:1538133806
Name:VANDENHEUVEL, CATHY L (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:L
Last Name:VANDENHEUVEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2010-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA209071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0165964Medicaid
MAVA-A32700Medicare ID - Type UnspecifiedSINCE 7/16/01
MAH42943Medicare UPIN