Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 138069-1 | NY |
N | 208600000X | Surgeon | 138069-1 | NY |
N | 208200000X | Surgeon | ME 121565 | FL |
N | 208600000X | Surgeon | ME 121565 | FL |
Y | 2086S0129X | Vascular Surgeon | MD028193E | PA |
NPI | 1164420816 |
---|---|
Provider Name | Dr. Boris Paul |
First Address | East Stroudsburg, PA 18301-7916 |
Second Address | East Stroudsburg, PA 18301-7916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 09/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001152624007 | (05) | PA |
C33877 | (02) |