Provider Demographics
NPI:1245308147
Name:IMBER, PAUL M (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:IMBER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PRIDES XING STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-6109
Mailing Address - Country:US
Mailing Address - Phone:302-998-0300
Mailing Address - Fax:302-999-7943
Practice Address - Street 1:1401 FOULK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2763
Practice Address - Country:US
Practice Address - Phone:302-998-0300
Practice Address - Fax:302-999-7943
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0002170207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000022603Medicaid
DE000022603Medicaid
B66591Medicare UPIN