Provider Demographics
NPI:1609819234
Name:COURNOYER, PAUL A (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:COURNOYER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:508-845-2711
Mailing Address - Fax:508-363-6866
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1864213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA7889OtherHARVARD PILGRIM HEALTH
MA9900277OtherFALLON HEALTH PLAN
MA468784OtherTUFTS HEALTH PLAN
MA0307530Medicaid
MAY70910OtherBLUE SHIELD OF MA
MAP00412548Medicare PIN
MA468784OtherTUFTS HEALTH PLAN
T51391Medicare UPIN
MA5081510001Medicare NSC