Provider Demographics
NPI:1225196413
Name:RAPPOPORT, PAUL S (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:RAPPOPORT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W VALLEY RD
Mailing Address - Street 2:SUITE #2704
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1824
Mailing Address - Country:US
Mailing Address - Phone:610-687-3940
Mailing Address - Fax:215-836-0562
Practice Address - Street 1:950 W VALLEY RD
Practice Address - Street 2:SUITE #2704
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1824
Practice Address - Country:US
Practice Address - Phone:610-687-3940
Practice Address - Fax:215-836-0562
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002752L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR06518Medicare UPIN
PARA186465Medicare ID - Type Unspecified