Provider Demographics
NPI:1578574737
Name:TRAUTMAN, PAUL DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DOUGLAS
Last Name:TRAUTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:140 CABRINI BLVD APT 59
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3433
Mailing Address - Country:US
Mailing Address - Phone:212-501-0228
Mailing Address - Fax:212-501-0228
Practice Address - Street 1:140 CABRINI BLVD APT 59
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3433
Practice Address - Country:US
Practice Address - Phone:212-501-0228
Practice Address - Fax:212-501-0228
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1296252084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY83A911Medicare UPIN