Provider Demographics
NPI:1235151820
Name:DAGINCOURT, PAUL G (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:DAGINCOURT
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 1:805 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2539
Mailing Address - Country:US
Mailing Address - Phone:781-929-4914
Mailing Address - Fax:781-329-2422
Practice Address - Street 1:805 HIGH ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2539
Practice Address - Country:US
Practice Address - Phone:781-929-4914
Practice Address - Fax:781-329-2422
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA718662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3108481Medicaid
MA3108481Medicaid