Provider Demographics
NPI:1003983735
Name:DEPAULA, GEOFFREY R (LIC AC)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:R
Last Name:DEPAULA
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2412
Mailing Address - Country:US
Mailing Address - Phone:508-435-8182
Mailing Address - Fax:
Practice Address - Street 1:77 W MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-1684
Practice Address - Country:US
Practice Address - Phone:508-435-8182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208015171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist