MEDICARE: DR. CATHARINE M. MINTZER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	58797	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013905652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHARINE M. MINTZER M.D.

Provider Business Mailing Address
First Line	:	377 WALNUT ST
Second Line	:
City	:	NEWTONVILLE
State	:	MA
Zip	:	02460-1945
Country	:	US
Telephone Number	:	617-964-7213
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 CONCORD AVE
Second Line	:	SUITE 4100
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-1040
Country	:	US
Telephone Number	:	617-864-8822
Fax Number	:	617-547-5367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/08/2007

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