Provider Demographics
NPI:1861477283
Name:HEINZELMANN, PAUL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:HEINZELMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NEW CHARDON ST
Mailing Address - Street 2:# 5917
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4774
Mailing Address - Country:US
Mailing Address - Phone:262-349-0126
Mailing Address - Fax:
Practice Address - Street 1:15 PARKMAN ST WAC 1
Practice Address - Street 2:MEDICAL WALK IN UNIT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-2707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA469545OtherTUFTS HEALTH PLAN
MA2076977Medicaid
MAJ27870OtherBCBS MA
MA469545OtherTUFTS HEALTH PLAN
MA2076977Medicaid