Provider Demographics
NPI:1891975157
Name:PAUL RADVANY MD PC
Entity Type:Organization
Organization Name:PAUL RADVANY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULO
Authorized Official - Middle Name:
Authorized Official - Last Name:RADVANY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-729-7472
Mailing Address - Street 1:15 DIX ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1870
Mailing Address - Country:US
Mailing Address - Phone:781-729-7472
Mailing Address - Fax:781-721-4584
Practice Address - Street 1:15 DIX ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1870
Practice Address - Country:US
Practice Address - Phone:781-729-7472
Practice Address - Fax:781-721-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37688207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2054477Medicaid
MAA66953Medicare UPIN
MA2054477Medicaid
MAM14108Medicare PIN