Provider Demographics
NPI:1114013596
Name:IANNINI, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:IANNINI
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 1:870 WESTOVER LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-5926
Mailing Address - Country:US
Mailing Address - Phone:717-650-6489
Mailing Address - Fax:
Practice Address - Street 1:870 WESTOVER LN
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5926
Practice Address - Country:US
Practice Address - Phone:717-650-6489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431902207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4275206OtherAETNA
PA1971886OtherHIGHMARK BLUE SHIELD
PA109229OtherGEISINGER
PA211103OtherJOHNS HOPKINS
PA109229OtherGEISINGER
PA112503Medicare PIN