Provider Demographics
NPI:1861481657
Name:SKUDDER, PAUL ALBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALBERT
Last Name:SKUDDER
Suffix:JR
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 1:100 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3063
Mailing Address - Country:US
Mailing Address - Phone:508-775-1984
Mailing Address - Fax:508-790-1987
Practice Address - Street 1:100 CAMP ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-775-1984
Practice Address - Fax:508-790-1987
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55871208600000X, 2086S0102X, 2086S0129X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01144650Medicaid
NYRA0788Medicare ID - Type Unspecified
NY01144650Medicaid