Provider Demographics
NPI:1851584189
Name:CARITAS PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:CARITAS PHYSICIAN NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF, HEMATOLOGY-ONCOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HESKETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-789-2317
Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:CARITAS PHYSICIA NETWORK
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:617-562-5488
Practice Address - Street 1:77 WARREN ST
Practice Address - Street 2:CARITAS PHYSICIAN NETWORK
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3601
Practice Address - Country:US
Practice Address - Phone:617-789-2317
Practice Address - Fax:617-562-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA98556261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2436OtherBC/BS
MA0324141Medicaid
MANP2436OtherBC/BS