Provider Demographics
NPI:1073558821
Name:PAUL, PRADEEP S (MD)
Entity Type:Individual
Prefix:
First Name:PRADEEP
Middle Name:S
Last Name:PAUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 934
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0934
Mailing Address - Country:US
Mailing Address - Phone:207-907-3339
Mailing Address - Fax:207-907-1214
Practice Address - Street 1:360 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3979
Practice Address - Country:US
Practice Address - Phone:207-907-3215
Practice Address - Fax:207-907-1795
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD16897208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431970799Medicaid
MEME1573Medicare ID - Type Unspecified
ME431970799Medicaid