Provider Demographics
NPI:1194714550
Name:FANG, PAULA M (MD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:FANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 GOVERNORS AVE
Mailing Address - Street 2:PROMPT CARE - LAWRENCE MEMORIAL HOSPITAL
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1643
Mailing Address - Country:US
Mailing Address - Phone:781-306-6180
Mailing Address - Fax:781-306-6206
Practice Address - Street 1:170 GOVERNORS AVE
Practice Address - Street 2:PROMPT CARE - LAWRENCE MEMORIAL HOSPITAL
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1643
Practice Address - Country:US
Practice Address - Phone:781-306-6180
Practice Address - Fax:781-306-6206
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA50814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1200992Medicaid
MAJ02674OtherBLUE CROSS LEGACY NUMBER
A56814Medicare UPIN
MA1200992Medicaid