MEDICARE: POCONO SURGICAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD028193E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245311067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POCONO SURGICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	391 E BROWN ST
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-9101
Country	:	US
Telephone Number	:	570-421-5997
Fax Number	:	570-421-7635

Provider Business Practice Location Address
First Line	:	391 E BROWN ST
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-9101
Country	:	US
Telephone Number	:	570-421-5997
Fax Number	:	570-421-7635

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BORIS PAUL
Credential	:	M.D.
Telephone Number	:	570-421-5997

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	03/02/2009

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Directions to “POCONO SURGICAL ASSOCIATES ” Practice Location

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