Provider Demographics
NPI:1508832643
Name:LARAIA, PAUL JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JEROME
Last Name:LARAIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03268-0004
Mailing Address - Country:US
Mailing Address - Phone:603-648-2375
Mailing Address - Fax:603-648-2270
Practice Address - Street 1:246 PLEASANT ST
Practice Address - Street 2:STE. 103
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2548
Practice Address - Country:US
Practice Address - Phone:603-224-6070
Practice Address - Fax:603-224-6094
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27661207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B75526Medicare UPIN