Provider Demographics
NPI:1003027202
Name:DEL VALLE, PAUL GASTON (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GASTON
Last Name:DEL VALLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:860 E BROAD ST
Mailing Address - Street 2:STE I
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6542
Mailing Address - Country:US
Mailing Address - Phone:740-348-4318
Mailing Address - Fax:740-348-4217
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1822
Practice Address - Country:US
Practice Address - Phone:740-348-4318
Practice Address - Fax:740-348-4217
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089044207L00000X, 2083P0901X
GA82167207L00000X, 2083P0901X
SC410452083P0901X
SCMD41045207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1003027202OtherNPI
OH2951257Medicaid
OH000000598891OtherANTHEM
OH2951257Medicaid
OHH146640Medicare PIN