Provider Demographics
NPI:1275813552
Name:AGUILLON, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:AGUILLON
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 1:401 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:BLADES
Mailing Address - State:DE
Mailing Address - Zip Code:19973-4274
Mailing Address - Country:US
Mailing Address - Phone:302-629-6664
Mailing Address - Fax:302-629-6134
Practice Address - Street 1:401 CONCORD RD
Practice Address - Street 2:
Practice Address - City:BLADES
Practice Address - State:DE
Practice Address - Zip Code:19973
Practice Address - Country:US
Practice Address - Phone:302-629-6664
Practice Address - Fax:302-629-6134
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DEC10011133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program