Provider Demographics
NPI:1528059144
Name:KINZFOGL, GEORGE P III (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:P
Last Name:KINZFOGL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:99 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6327
Mailing Address - Country:US
Mailing Address - Phone:508-875-4811
Mailing Address - Fax:508-875-5942
Practice Address - Street 1:99 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6327
Practice Address - Country:US
Practice Address - Phone:508-875-4811
Practice Address - Fax:508-875-5942
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA214550207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA15449OtherHPHC
MA2045222Medicaid
MAJ27251OtherBCBSMA
3465688OtherCIGNA
3543758OtherAETNA/USHC
465552OtherTUFTS
P001177639OtherPALMETTO GBA (RR MCARE)
0032798OtherNHP
86109OtherFALLON
030390670OtherUHC
MAJ27251OtherBCBSMA
P001177639OtherPALMETTO GBA (RR MCARE)