Provider Demographics
NPI:1598759367
Name:POULIN, PAUL F (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:POULIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:F
Other - Last Name:POULIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3 ELECTRONICS AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1099
Mailing Address - Country:US
Mailing Address - Phone:978-750-0300
Mailing Address - Fax:978-279-1324
Practice Address - Street 1:62 BROWN ST
Practice Address - Street 2:SUITE #401
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6778
Practice Address - Country:US
Practice Address - Phone:978-521-8590
Practice Address - Fax:978-521-8732
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9050207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110064751AMedicaid
MARE751202Medicare PIN
MAA56959Medicare UPIN