Provider Demographics
NPI:1811915010
Name:MAXWELL, PAUL (FNP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-4026
Mailing Address - Fax:585-922-4790
Practice Address - Street 1:1425 PORTLAND AVE # 298
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3011
Practice Address - Country:US
Practice Address - Phone:585-922-4026
Practice Address - Fax:585-922-4790
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333043363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02388205Medicaid
NYJ400148606Medicare PIN
NYJ100058113/WNYMedicare PIN
NYJ400148610Medicare PIN
NY70005A/RGHMedicare PIN