Provider Demographics
NPI:1700873312
Name:SIMPSON, PAUL KERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KERRY
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E. THIRD ST.
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701
Mailing Address - Country:US
Mailing Address - Phone:570-505-3180
Mailing Address - Fax:570-505-3184
Practice Address - Street 1:1101 E. THIRD ST.
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701
Practice Address - Country:US
Practice Address - Phone:570-505-3180
Practice Address - Fax:570-505-3184
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070363L207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017946810002Medicaid
E86194Medicare UPIN
PA581375Medicare PIN