Provider Demographics
NPI:1811994593
Name:PARKER, PAUL J (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BURNETT CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-4410
Mailing Address - Country:US
Mailing Address - Phone:802-434-5090
Mailing Address - Fax:802-329-2144
Practice Address - Street 1:12 BURNETT CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VT
Practice Address - Zip Code:05477-4410
Practice Address - Country:US
Practice Address - Phone:802-434-5090
Practice Address - Fax:802-329-2144
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0009376208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
4798451OtherCIGNA
VT0VN1473Medicaid
VT00068257OtherBLUECROSSBLUESHIELD
4142307OtherMVP HEALTHCARE
4142307OtherMVP HEALTHCARE
4798451OtherCIGNA