Provider Demographics
NPI:1992971345
Name:PAULA A. FONTAINE DPM
Entity type:Organization
Organization Name:PAULA A. FONTAINE DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-874-1300
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPOD 2063213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5048920001Medicare NSC