Provider Demographics
NPI:1659465466
Name:JOHN H PAUL M D INC
Entity type:Organization
Organization Name:JOHN H PAUL M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HARSHA
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-352-0719
Mailing Address - Street 1:50 NORMANDY DR
Mailing Address - Street 2:STE 2
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1600
Mailing Address - Country:US
Mailing Address - Phone:440-352-0719
Mailing Address - Fax:440-352-3095
Practice Address - Street 1:50 NORMANDY DR
Practice Address - Street 2:STE 2
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1600
Practice Address - Country:US
Practice Address - Phone:440-352-0719
Practice Address - Fax:440-352-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-4366-P174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0196916Medicaid
OHA74814Medicare UPIN
OH0196916Medicaid