Provider Demographics
NPI:1346402310
Name:RICHELSON, PAUL S (C,PED)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:RICHELSON
Suffix:
Gender:M
Credentials:C,PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TOWN WEST RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-3428
Mailing Address - Country:US
Mailing Address - Phone:603-536-3338
Mailing Address - Fax:
Practice Address - Street 1:7 TOWN WEST RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3428
Practice Address - Country:US
Practice Address - Phone:603-536-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0732110001Medicare NSC