Provider Demographics
NPI:1649223355
Name:SIFFRI, PAUL CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:CHARLES
Last Name:SIFFRI
Suffix:
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR STE C100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6322
Practice Address - Country:US
Practice Address - Phone:864-454-7422
Practice Address - Fax:864-454-8265
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27666207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576007863130OtherBLUECHOICE HEALTHPLAN ID
SCP00802347OtherRR MEDICARE
SC576007863158OtherBCBS OF SC ID
SC276668Medicaid
SCP00288148OtherRR MEDICARE
SC7386697OtherAETNA ID
SCI40445Medicare UPIN
SC1404458299Medicare PIN
SC276668Medicaid