Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 73761 | MA |
NPI | 1003801523 |
---|---|
Provider Name | Paul Esielionis |
First Address | Lawrence, MA 01841-4396 |
Second Address | Lawrence, MA 01841-4396 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 01/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1303775 | (05) | MA |
E93130 | (02) |