Provider Demographics
NPI:1578545562
Name:MENITOFF, PAUL A (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:MENITOFF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:73 PRINCETON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:N CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1558
Mailing Address - Country:US
Mailing Address - Phone:978-256-6579
Mailing Address - Fax:978-256-1943
Practice Address - Street 1:73 PRINCETON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:N CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1558
Practice Address - Country:US
Practice Address - Phone:978-256-6579
Practice Address - Fax:978-256-1943
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2015-05-18
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Provider Licenses
StateLicense IDTaxonomies
MA451992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0022320OtherNHP
MA0195618Medicaid
MA700947OtherSECURE HORIZON
MA015479OtherTRICARE
MA043476807-10OtherPACIFICARE
MA93685000OtherMAGELLAN
MA1042592OtherCIGNA
MA978790OtherNETWORK HEALTH
MA260042644OtherRAILROAD MEDICARE
MAB13055OtherBCBSMA
NH01Y001001MA01OtherANTHEM BCBSNH
MA4598495OtherAETNA
MA700947OtherTUFTS
MA260042644OtherRAILROAD MEDICARE
MAA34193Medicare UPIN