Provider Demographics
NPI:1255344347
Name:CIAVARELLI, PAUL J JR (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:CIAVARELLI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2304 GATEWAY DR STE B
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-7273
Mailing Address - Country:US
Mailing Address - Phone:334-741-7600
Mailing Address - Fax:801-383-5077
Practice Address - Street 1:2304 GATEWAY DR STE B
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7273
Practice Address - Country:US
Practice Address - Phone:334-741-7600
Practice Address - Fax:847-241-7600
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL179213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51536299OtherBCBS
AL51536300OtherBCBS
AL51038839OtherBCBS
AL51536298OtherBCBS
AL000038839Medicare PIN
AL51038839OtherBCBS
AL4747100001Medicare NSC