Provider Demographics
NPI:1770544256
Name:RICHARDSON, PAUL G (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:44 BINNEY STREET
Mailing Address - Street 2:D1B30 DANA FARBER CANCER INSTITUTE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-632-2104
Mailing Address - Fax:617-632-6624
Practice Address - Street 1:44 BINNEY STREET
Practice Address - Street 2:DANA FARBER CANCER INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-2104
Practice Address - Fax:617-632-6624
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-01
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
MA78553207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
31374OtherFALLON COMMUNITY HEALTH P
MAJ30533OtherBLUE CROSS BLUE SHIELD
6533115OtherCIGNA
2067414OtherAETNA US HEALTHCARE
MA3124703Medicaid
F80444DFOtherHPHC
758066OtherTUFTS
3004460OtherUNITED HEALTH CARE
758066OtherTUFTS
F80444Medicare UPIN