Provider Demographics
NPI:1851356133
Name:AMOROSO, PAUL J (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:AMOROSO
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 FITZSIMONS DRIVE, ATTN: MCHJ-CI
Mailing Address - Street 2:CREDENTENTIAL'S OFFICE, MADIGAN ARMY MEDICAL CENTER
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431
Mailing Address - Country:US
Mailing Address - Phone:253-968-1160
Mailing Address - Fax:253-399-2882
Practice Address - Street 1:CREDENTENTIALS OFFICE MADIGAN ARMY MEDICAL CTR
Practice Address - Street 2:9040 FITZSIMONS DRIVE, ATTN: MCHJ-CI
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-1160
Practice Address - Fax:253-399-2882
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA567232083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN
33025FMedicare ID - Type Unspecified