Provider Demographics
NPI:1811955958
Name:WATERS, PAUL FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FREDERICK
Last Name:WATERS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:55 MAMARONECK RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2823
Mailing Address - Country:US
Mailing Address - Phone:914-472-2320
Mailing Address - Fax:914-472-2838
Practice Address - Street 1:77 LAFAYETTE PL
Practice Address - Street 2:SUITE 302
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5426
Practice Address - Country:US
Practice Address - Phone:203-868-4341
Practice Address - Fax:914-472-2838
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT040613208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
C35703Medicare UPIN