Individual
DR. PAUL A CANNISTRARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12 ARROW ST STE 210, CAMBRIDGE, MA 02138-5105
(617) 460-1053
(617) 848-9485
Mailing address
12 ARROW ST STE 210, CAMBRIDGE, MA 02138-5105
(617) 460-1053
(617) 848-9485
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
215892
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2042291
—
MA
01
—
469409
TUFTS HEALTH PLAN
MA
01
—
J27378
BLUE CROSS BLUE SHIELD
MA
Enumeration date
09/22/2005
Last updated
11/13/2020
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