Provider Demographics
NPI:1821096157
Name:DICESARE, PAUL ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ERIC
Last Name:DICESARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1544 WEATHERLY ROAD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011
Mailing Address - Country:US
Mailing Address - Phone:916-734-5885
Mailing Address - Fax:916-734-7904
Practice Address - Street 1:1544 WEATHERLY ROAD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011
Practice Address - Country:US
Practice Address - Phone:422-244-7177
Practice Address - Fax:916-703-5074
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190463207XS0114X
CAG62347207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050599Medicaid
NYF44551Medicare UPIN
20LS31Medicare ID - Type Unspecified