Provider Demographics
NPI:1801340955
Name:HEALEY, PAUL SR
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:HEALEY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SOMERSETT DR
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-2152
Mailing Address - Country:US
Mailing Address - Phone:860-536-4225
Mailing Address - Fax:
Practice Address - Street 1:108 SOMERSETT DR
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2152
Practice Address - Country:US
Practice Address - Phone:860-536-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0385322083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine