Provider Demographics
NPI:1275522914
Name:ORANGE, PAUL DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DOUGLAS
Last Name:ORANGE
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 1:4225 LINCOLN WAY E
Mailing Address - Street 2:P.O. BOX 608
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17222-1051
Mailing Address - Country:US
Mailing Address - Phone:717-352-3616
Mailing Address - Fax:717-352-9013
Practice Address - Street 1:4225 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17222-1051
Practice Address - Country:US
Practice Address - Phone:717-352-3616
Practice Address - Fax:717-352-9013
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-16
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039208L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0988617Medicaid
PAP00464067OtherRAILROAD MEDICARE
PAB36806Medicare UPIN
PA109425Medicare PIN