Provider Demographics
NPI:1598779860
Name:PAUL A. COURNOYER D.P.M., P.C.
Entity Type:Organization
Organization Name:PAUL A. COURNOYER D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:COURNOYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-363-6868
Mailing Address - Street 1:5 HEMLOCK CIR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-1572
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 550
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-363-6868
Practice Address - Fax:508-363-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1864213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA691584OtherTUFTS HEALTH PLAN
MA80767OtherFALLON HEALTH PLAN
MA9719610Medicaid
MAY77331OtherBLUE SHEILD OF MA
MAAA7889OtherHARVARD PILGRIM HEALTH
MAY77331OtherBLUE SHEILD OF MA
MAT51391Medicare UPIN
MA9719610Medicaid
MA5081510001Medicare NSC