Provider Demographics
NPI:1609837863
Name:PAOLINI, RAYMOND V JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:V
Last Name:PAOLINI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-634-6224
Mailing Address - Fax:716-634-3816
Practice Address - Street 1:6645 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-634-6224
Practice Address - Fax:716-634-3816
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186332207Y00000X, 207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01766581Medicaid
NY000524678009OtherBCBS
G47847Medicare UPIN
NY01766581Medicaid