Provider Demographics
NPI:1558447151
Name:HITZHUSEN, JANICE C (MD)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:C
Last Name:HITZHUSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 LINCOLN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2528
Mailing Address - Country:US
Mailing Address - Phone:508-756-0111
Mailing Address - Fax:508-756-0222
Practice Address - Street 1:200 LINCOLN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2528
Practice Address - Country:US
Practice Address - Phone:508-756-0111
Practice Address - Fax:508-756-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAMA46700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA352070OtherCIGNA
MA2093898Medicaid
MAJ02195OtherBLUE CROSS
MA64643OtherHARVARD PILGRIM
MA714039OtherTUFTS
MA18097OtherFALLON
MAJ02195Medicare ID - Type Unspecified
MA2093898Medicaid