Provider Demographics
NPI:1063579886
Name:MUSCO, PAUL S (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:MUSCO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-0706
Mailing Address - Country:US
Mailing Address - Phone:314-989-0300
Mailing Address - Fax:603-238-2163
Practice Address - Street 1:103 BOULDER POINT DRIVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3168
Practice Address - Country:US
Practice Address - Phone:603-536-1284
Practice Address - Fax:603-536-3136
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD07090207W00000X
NH17272207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180005429OtherRAILROAD MEDICARE
RI2443-5OtherBLUE CROSS BLUE SHIELD
RI202101OtherBLUECHIP
08-001055OtherUNITED HEALTHCARE
RIMD07090OtherRI MEDICAL LICENSE
RI9002443Medicaid
RI9002443Medicaid
08-001055OtherUNITED HEALTHCARE
RI202101OtherBLUECHIP
AM3073400OtherDEA