Provider Demographics
NPI:1417722174
Name:PAUL, CAROL
Entity Type:Individual
Prefix:MR
First Name:CAROL
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAROL PAUL
Mailing Address - Street 1:14 CEDAR GRV
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:ME
Mailing Address - Zip Code:04640-3204
Mailing Address - Country:US
Mailing Address - Phone:207-239-4080
Mailing Address - Fax:
Practice Address - Street 1:14 CEDAR GRV
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:ME
Practice Address - Zip Code:04640-3204
Practice Address - Country:US
Practice Address - Phone:207-239-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
123456171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor