Provider Demographics
NPI:1780654004
Name:FONTAINE, PAULA A (DPM)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:A
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 STATE RD E
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01473-1212
Mailing Address - Country:US
Mailing Address - Phone:978-874-1300
Mailing Address - Fax:978-874-6244
Practice Address - Street 1:32 STATE RD E
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1212
Practice Address - Country:US
Practice Address - Phone:978-874-1300
Practice Address - Fax:978-874-6244
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2063213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6826OtherFALLON HEALTH PLAN
MAAA21094OtherHARVARD PILGRIM HEALTH
MA002063OtherTUFTS HEALTH PLAN
MAY71034OtherBLUE SHIELD OF MA
MA0307602Medicaid
MAU63205Medicare UPIN
MAAA21094OtherHARVARD PILGRIM HEALTH
MA6826OtherFALLON HEALTH PLAN
MA0307602Medicaid