Provider Demographics
NPI:1538152574
Name:HARASIMOWICZ, PAUL P III (M D)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:P
Last Name:HARASIMOWICZ
Suffix:III
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 GROTON RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-1124
Mailing Address - Country:US
Mailing Address - Phone:978-772-9846
Mailing Address - Fax:978-772-1180
Practice Address - Street 1:190 GROTON RD
Practice Address - Street 2:SUITE 160
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432-1124
Practice Address - Country:US
Practice Address - Phone:978-772-9846
Practice Address - Fax:978-772-1180
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73797174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3078272Medicaid
MA9779612Medicaid
MA3078272Medicaid
MAJ11220Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
MAE86638Medicare UPIN