Provider Demographics
NPI:1629075759
Name:PAUL, STEPHEN E (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:PAUL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-2679
Mailing Address - Country:US
Mailing Address - Phone:856-779-9220
Mailing Address - Fax:856-779-7890
Practice Address - Street 1:111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-2679
Practice Address - Country:US
Practice Address - Phone:856-779-9220
Practice Address - Fax:856-779-7890
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02548900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080169223OtherRAILROAD MEDICARE
NJ2433109Medicaid
NJ037144Y2SMedicare PIN
NJ2433109Medicaid