Provider Demographics
NPI:1609848076
Name:PAULSON, ERIC PUCCINI (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:PUCCINI
Last Name:PAULSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MONTVALE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2445
Mailing Address - Country:US
Mailing Address - Phone:781-279-0971
Mailing Address - Fax:617-573-5646
Practice Address - Street 1:41 MONTVALE AVE STE 200
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-2445
Practice Address - Country:US
Practice Address - Phone:781-279-0971
Practice Address - Fax:617-573-5646
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1021604207Y00000X
CAA95370207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI03181Medicare UPIN