Provider Demographics
NPI:1831197748
Name:PAUL-BLANC, RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:PAUL-BLANC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 MAIN ST
Mailing Address - Street 2:STE. 670
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1604
Mailing Address - Country:US
Mailing Address - Phone:508-754-3566
Mailing Address - Fax:508-438-6368
Practice Address - Street 1:16 CREEDEN ST
Practice Address - Street 2:#4
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1212
Practice Address - Country:US
Practice Address - Phone:508-339-3600
Practice Address - Fax:508-339-8831
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA46432208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3068501Medicaid
E47185Medicare UPIN
MA3068501Medicaid
MAJ0995001Medicare PIN