1548274012 NPI number — DR. GERARDO B PAULINO M.D.

Table of content: DR. GERARDO B PAULINO M.D. (NPI 1548274012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548274012 NPI number — DR. GERARDO B PAULINO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAULINO
Provider First Name:
GERARDO
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548274012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 799
Provider Second Line Business Mailing Address:
21 COLLETTE RD
Provider Business Mailing Address City Name:
FISKDALE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01518-1172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-347-0906
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-967-2272
Provider Business Practice Location Address Fax Number:
413-967-2330
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  37301 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MA2026562 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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