Provider Demographics
NPI:1730207325
Name:FOOTE, CAROLINE BRECKWOLDT (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:BRECKWOLDT
Last Name:FOOTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-4260
Mailing Address - Country:US
Mailing Address - Phone:781-756-7273
Mailing Address - Fax:781-721-0725
Practice Address - Street 1:1021 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890
Practice Address - Country:US
Practice Address - Phone:781-729-1021
Practice Address - Fax:781-729-7504
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72100207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3049680OtherMASS HEALTH
MAJ08602Medicare ID - Type Unspecified
MA3049680OtherMASS HEALTH