Healthcare Provider Details

I. General information

NPI: 1942367206
Provider Name (Legal Business Name): PAUL L. GELTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST CAMBRIDGE PEDIATRICS
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

1493 CAMBRIDGE ST CAMBRIDGE HEALTH ALLIANCE, MACHT 3
CAMBRIDGE MA
02139-1047
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1264
  • Fax: 617-665-1835
Mailing address:
  • Phone: 617-665-1497
  • Fax: 617-665-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number80159
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: