Provider Demographics
NPI:1659438539
Name:RAYMOND PAUL-BLANC, MD, PC
Entity Type:Organization
Organization Name:RAYMOND PAUL-BLANC, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL-BLANC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-339-3600
Mailing Address - Street 1:340 MAIN ST
Mailing Address - Street 2:STE. 670
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1604
Mailing Address - Country:US
Mailing Address - Phone:508-754-3566
Mailing Address - Fax:508-438-6368
Practice Address - Street 1:16 CREEDEN ST
Practice Address - Street 2:#4
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1212
Practice Address - Country:US
Practice Address - Phone:508-339-3600
Practice Address - Fax:508-339-3831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9781901Medicaid
MA9781901Medicaid