Healthcare Provider Details

I. General information

NPI: 1578545562
Provider Name (Legal Business Name): PAUL A MENITOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 PRINCETON ST SUITE 203
N CHELMSFORD MA
01863-1558
US

IV. Provider business mailing address

73 PRINCETON ST SUITE 203
N CHELMSFORD MA
01863-1558
US

V. Phone/Fax

Practice location:
  • Phone: 978-256-6579
  • Fax: 978-256-1943
Mailing address:
  • Phone: 978-256-6579
  • Fax: 978-256-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number45199
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: