Provider Demographics
NPI:1912026519
Name:PAULSON, DAVID MERLIN (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MERLIN
Last Name:PAULSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 CRYSTAL PL
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-7995
Mailing Address - Country:US
Mailing Address - Phone:919-894-5730
Mailing Address - Fax:
Practice Address - Street 1:350 PINESTATE ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546
Practice Address - Country:US
Practice Address - Phone:910-893-9700
Practice Address - Fax:910-893-9747
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101691363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS92007Medicare UPIN
NC2752665Medicare ID - Type UnspecifiedPERFORMING PROVIDER NUMBE