Provider Demographics
NPI:1164420816
Name:PAUL, BORIS (MD,FACS)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 INDEPENDENCE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7916
Mailing Address - Country:US
Mailing Address - Phone:570-421-5997
Mailing Address - Fax:570-421-7635
Practice Address - Street 1:505 INDEPENDENCE RD
Practice Address - Street 2:STE E
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7916
Practice Address - Country:US
Practice Address - Phone:570-421-5997
Practice Address - Fax:570-421-7635
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028193E2086S0129X
NY138069-1208600000X
FLME 121565208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001152624007Medicaid
PA001152624007Medicaid
PA118962Medicare PIN
PA001152624007Medicaid