1932212206 NPI number — DR. PAUL F LIZZUL MD, PHD, MPH, MBA

Table of content: DR. PAUL F LIZZUL MD, PHD, MPH, MBA (NPI 1932212206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932212206 NPI number — DR. PAUL F LIZZUL MD, PHD, MPH, MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIZZUL
Provider First Name:
PAUL
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD, MPH, MBA
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:
1932212206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 WASHINGTON ST, BOX 114
Provider Second Line Business Mailing Address:
TUFTS MEDICAL CENTER, DEPT OF DERMATOLOGY
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-636-5000
Provider Business Mailing Address Fax Number:
617-636-8316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 WASHINGTON ST
Provider Second Line Business Practice Location Address:
TUFTS MEDICAL CENTER, DEPARTMENT OF DERMATOLOGY
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02111-1552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-636-1056
Provider Business Practice Location Address Fax Number:
617-636-9169
Provider Enumeration Date:
08/17/2006

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: 207N00000X , with the licence number:  A96670 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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