Provider Demographics
NPI:1275896615
Name:AITA, PAUL CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:CHARLES
Last Name:AITA
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 1:1509 OLD MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2836
Mailing Address - Country:US
Mailing Address - Phone:610-374-4062
Mailing Address - Fax:
Practice Address - Street 1:1509 OLD MILL ROAD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2836
Practice Address - Country:US
Practice Address - Phone:610-374-4062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009372E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery