Provider Demographics
NPI:1558328716
Name:HEINSOHN, CARMEL REID (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEL
Middle Name:REID
Last Name:HEINSOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28 BEAVERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1522
Mailing Address - Country:US
Mailing Address - Phone:508-816-6623
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTH ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02467-3658
Practice Address - Country:US
Practice Address - Phone:617-676-3315
Practice Address - Fax:617-469-5013
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA591252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3036120Medicaid
MAA66633Medicare UPIN
MA3036120Medicaid