Provider Demographics
NPI:1386611630
Name:HERTL, MARY CATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CATHERINE
Last Name:HERTL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:5 ESSEX GREEN DR
Mailing Address - Street 2:STE 36
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2921
Mailing Address - Country:US
Mailing Address - Phone:978-969-2081
Mailing Address - Fax:978-969-2084
Practice Address - Street 1:900 CUMMINGS CTR
Practice Address - Street 2:STE 216T
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6225
Practice Address - Country:US
Practice Address - Phone:978-969-2081
Practice Address - Fax:978-969-2084
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2016-07-26
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Provider Licenses
StateLicense IDTaxonomies
MA212487208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0183466Medicaid
MA212487OtherTUFTS HEALTH PLAN
MAJ25485OtherBCBS MA
MA212487OtherTUFTS HEALTH PLAN
MAJ25485OtherBCBS MA