Provider Demographics
NPI:1306926282
Name:DAVIDSON, PAUL GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GREGORY
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4401 MIDDLE SETTLEMENT ROAD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413
Mailing Address - Country:US
Mailing Address - Phone:315-797-3430
Mailing Address - Fax:315-624-7383
Practice Address - Street 1:4401 MIDDLE SETTLEMENT ROAD
Practice Address - Street 2:SUITE 208
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413
Practice Address - Country:US
Practice Address - Phone:315-797-3430
Practice Address - Fax:315-624-7383
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY172748208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01249678Medicaid
NY01249678Medicaid
NYE89789Medicare UPIN