Provider Demographics
NPI:1336103860
Name:CARMICHAEL, PAULA G (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:G
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-595-2000
Mailing Address - Fax:508-853-7149
Practice Address - Street 1:630 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-595-2000
Practice Address - Fax:508-853-7149
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04011717OtherEVERCARE
J14923OtherBLUE CARE ELECT
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTHREE RIVERS
042472266OtherONE HEALTH PLAN
AA1282OtherHARVARD PILGRIM HEALTHCAR
043058466OtherHEALTHCARE VALUE MGMT
1059645OtherFIRST HEALTH
MA3131416Medicaid
784248OtherMVP HEALTH CARE
J14923OtherMEDICARE B
2486213OtherAETNA US HEALTHCARE
26785OtherCHILDRENS MED SEC PLAN
26785OtherHEALTHY START
991129OtherFALLON COMMUNITY HEALTH P
J14923OtherBLUE SHIELD INDEMNITY
J14923OtherBLUE SHIELD HMO BLUE
4061873OtherCIGNA HEALTH PLAN
J14923OtherMEDICARE B
J14923OtherBLUE CARE ELECT