Provider Demographics
NPI:1508807769
Name:PAUL, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:PAUL
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 1:2 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2828 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1722
Practice Address - Country:US
Practice Address - Phone:716-838-1300
Practice Address - Fax:716-837-7725
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14175112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01065269Medicaid
00025104403OtherUNIVERA
100891FFOtherPREFERRED CARE
P00048700OtherRAILROAD MEDICARE
000510203004OtherBLUE SHIELD OF WESTERN NY
5606193OtherINDEPENDANT HEALTH
NYR1417318OtherWORKERS COMPENSATION
000510203004OtherBLUE SHIELD OF WESTERN NY
NYCC8474Medicare PIN