Provider Demographics
NPI:1548210966
Name:PAUL, TANYA RENEE (MD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:RENEE
Last Name:PAUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 LANSING ST FL 1
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-252-5082
Mailing Address - Fax:315-252-1587
Practice Address - Street 1:17 LANSING STREET, 1ST FLOOR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1852
Practice Address - Country:US
Practice Address - Phone:315-252-5082
Practice Address - Fax:315-252-1587
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY218915207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02097161Medicaid
NY02097161Medicaid
NY808E91Medicare ID - Type Unspecified
PA101516865 0001Medicaid