Provider Demographics
NPI:1851361992
Name:MAYER, PAUL J (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:MAYER
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 1:60 COLCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1424
Mailing Address - Country:US
Mailing Address - Phone:802-864-7483
Mailing Address - Fax:802-660-4337
Practice Address - Street 1:60 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1424
Practice Address - Country:US
Practice Address - Phone:802-864-7483
Practice Address - Fax:802-660-4337
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420004407207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00004522OtherBLUE CROSS/BLUE SHIELD
VT0004522Medicaid
VT0004522Medicaid
VT4522Medicare ID - Type Unspecified