Provider Demographics
NPI:1457342958
Name:GERALDEZ, PAUL ILIGAN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ILIGAN
Last Name:GERALDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 EAST ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1998
Mailing Address - Country:US
Mailing Address - Phone:978-851-7321
Mailing Address - Fax:978-858-3795
Practice Address - Street 1:365 EAST ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1998
Practice Address - Country:US
Practice Address - Phone:978-851-7321
Practice Address - Fax:978-858-3795
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12490207R00000X
MA216611207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2011328Medicaid
H81902Medicare UPIN
MA2011328Medicaid