Provider Demographics
NPI:1679034003
Name:WAKSMAN, PAUL BENJAMIN (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:BENJAMIN
Last Name:WAKSMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 NORTH ST STE A
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3825
Mailing Address - Country:US
Mailing Address - Phone:508-775-8282
Mailing Address - Fax:508-775-8280
Practice Address - Street 1:18 ROUTE 6A
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-5309
Practice Address - Country:US
Practice Address - Phone:508-775-8282
Practice Address - Fax:508-775-8280
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA8561363AM0700X
390200000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program