Provider Demographics
NPI:1093997280
Name:CUSTODIO, PAUL JEROME PALAFOX (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL JEROME
Middle Name:PALAFOX
Last Name:CUSTODIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:356 FREEPORT ST
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-6071
Mailing Address - Country:US
Mailing Address - Phone:724-367-2400
Mailing Address - Fax:724-367-2401
Practice Address - Street 1:356 FREEPORT ST
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-6071
Practice Address - Country:US
Practice Address - Phone:724-367-2400
Practice Address - Fax:724-367-2401
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2020-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD456308207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103209442Medicaid
PA536142Medicare PIN