Provider Demographics
NPI:1528055563
Name:PAUL, DAVID W (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:PAUL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5103
Mailing Address - Country:US
Mailing Address - Phone:215-707-3326
Mailing Address - Fax:157-078-0282
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-3326
Practice Address - Fax:157-078-0282
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0007898207L00000X
PAOS011882207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA35800OtherABA CERTIFICATE
PAP00918741OtherRAILROAD MEDICARE
PA001911527Medicaid
1005OtherAOA CERTIFICATE
PA001911527Medicaid