Provider Demographics
NPI:1699271882
Name:BARESEL, PAUL CHARLES IV (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:CHARLES
Last Name:BARESEL
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1800 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6797
Mailing Address - Country:US
Mailing Address - Phone:814-278-4818
Mailing Address - Fax:814-234-6150
Practice Address - Street 1:303 BENNER PIKE STE 1
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7301
Practice Address - Country:US
Practice Address - Phone:814-272-5660
Practice Address - Fax:814-272-5675
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2024-01-26
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Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD473938207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist