Provider Demographics
NPI:1609832492
Name:RADVANY, PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:RADVANY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PAULO
Other - Middle Name:
Other - Last Name:RADVANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5627
Mailing Address - Country:US
Mailing Address - Phone:781-862-5918
Mailing Address - Fax:
Practice Address - Street 1:1021 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1942
Practice Address - Country:US
Practice Address - Phone:781-729-7472
Practice Address - Fax:781-729-7470
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37688207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA66953Medicare UPIN