Provider Demographics
NPI:1194825208
Name:BRISSON, PAUL A (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:BRISSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:624 MCCLELLAN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1020
Mailing Address - Country:US
Mailing Address - Phone:518-377-6429
Mailing Address - Fax:518-377-1291
Practice Address - Street 1:624 MCCLELLAN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1020
Practice Address - Country:US
Practice Address - Phone:518-377-6429
Practice Address - Fax:518-377-1291
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY164835208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10000212OtherCDPDP
NY28F363OtherBC
NY02223OtherMVP
NY1000052185OtherAFFINITY
NY01069227Medicaid
NY040426006654OtherFIDELIS
NY01069227Medicaid
NY040426006654OtherFIDELIS