Provider Demographics
NPI:1548379654
Name:KRIEGSTEIN, HENRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:J
Last Name:KRIEGSTEIN
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 1:45 RESNIK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4844
Mailing Address - Country:US
Mailing Address - Phone:508-747-4748
Mailing Address - Fax:508-747-0124
Practice Address - Street 1:45 RESNIK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4844
Practice Address - Country:US
Practice Address - Phone:508-747-4748
Practice Address - Fax:508-747-0124
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA042947207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0163619Medicaid
MADX5878OtherMEDICARE ID
MAA59692Medicare UPIN
MAJ10045Medicare ID - Type Unspecified