Provider Demographics
NPI:1639165624
Name:HAMBURG, PAUL (PAUL HAMBURG)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:HAMBURG
Suffix:
Gender:M
Credentials:PAUL HAMBURG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 RISLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3276
Mailing Address - Country:US
Mailing Address - Phone:617-731-4451
Mailing Address - Fax:
Practice Address - Street 1:9 BABCOCK ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5903
Practice Address - Country:US
Practice Address - Phone:617-566-5816
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA511612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA714687AOtherTUFTS HEALTH PLAN
MAJ04830OtherBLUE CROSS BLUE SHIELD ID
MAA58072Medicare UPIN