Provider Demographics
NPI:1780635573
Name:BURNS, PAUL G (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:BURNS
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 1:22 MILL STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476
Mailing Address - Country:US
Mailing Address - Phone:781-648-3007
Mailing Address - Fax:781-643-7274
Practice Address - Street 1:22 MILL STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476
Practice Address - Country:US
Practice Address - Phone:781-648-3007
Practice Address - Fax:781-643-7274
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA44870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA044870OtherTUFTS
MA60532OtherHARVARD PILGRIM
MAB27161OtherBCBS
MA2077949Medicaid
MAB27161OtherBCBS
B97001Medicare UPIN