Provider Demographics
NPI:1083617146
Name:PALUMBO, PAUL F (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:PALUMBO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-1208
Mailing Address - Country:US
Mailing Address - Phone:315-271-9346
Mailing Address - Fax:315-507-2449
Practice Address - Street 1:421 BROAD ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-1208
Practice Address - Country:US
Practice Address - Phone:315-271-9346
Practice Address - Fax:315-507-2449
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186525207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00310852Medicaid
NY00310852Medicaid
F04492Medicare UPIN