Provider Demographics
NPI:1336179993
Name:FINE, PAUL H (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:H
Last Name:FINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2400 S CLINTON AVE
Mailing Address - Street 2:BLDG H SUITE 230
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2668
Mailing Address - Country:US
Mailing Address - Phone:585-341-7200
Mailing Address - Fax:585-325-6051
Practice Address - Street 1:2400 S CLINTON AVE
Practice Address - Street 2:BLDG H SUITE 230
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2668
Practice Address - Country:US
Practice Address - Phone:585-341-7200
Practice Address - Fax:585-325-6051
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY087918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB72192Medicare UPIN
NYRA8134Medicare PIN