Provider Demographics
NPI:1306930243
Name:PAULIN, MITCHELL H (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:H
Last Name:PAULIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:21 INDUSTRIAL BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1610
Mailing Address - Country:US
Mailing Address - Phone:610-640-7434
Mailing Address - Fax:610-640-7436
Practice Address - Street 1:21 INDUSTRIAL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1610
Practice Address - Country:US
Practice Address - Phone:610-640-7434
Practice Address - Fax:610-640-7436
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD041363L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000916701Medicaid
DE0000916701Medicaid
PA005736Medicare PIN