Provider Demographics
NPI:1619922499
Name:KANZARIA, PAULOMI K (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULOMI
Middle Name:K
Last Name:KANZARIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RICE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01468-1332
Mailing Address - Country:US
Mailing Address - Phone:978-939-2035
Mailing Address - Fax:978-939-2039
Practice Address - Street 1:14 RICE RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:MA
Practice Address - Zip Code:01468-1332
Practice Address - Country:US
Practice Address - Phone:978-939-2035
Practice Address - Fax:978-939-2039
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA422732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0139432Medicaid
MA0139432Medicaid
MAKA N01918Medicare ID - Type Unspecified