Provider Demographics
NPI:1013952274
Name:CERZA, PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:CERZA
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:PO BOX 370337
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06137-0337
Mailing Address - Country:US
Mailing Address - Phone:860-523-9836
Mailing Address - Fax:860-523-9836
Practice Address - Street 1:71 HAYNES ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4131
Practice Address - Country:US
Practice Address - Phone:860-523-9836
Practice Address - Fax:860-523-9836
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017073208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050614OtherCONNECTICARE
CTOVO 141OtherHEALTHNET
CT010017073CT02OtherANTHEM BLUE
CTHAS 727OtherOXFORD HEALTH PLAN
CT073881OtherAETNA
CT010017073CT02OtherANTHEM BLUE