MEDICARE: PAUL T ZAYDON,MD

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1265447049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL T ZAYDON,MD

Provider Business Mailing Address
First Line	:	115 NEWPORT AVE
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02861-4107
Country	:	US
Telephone Number	:	401-723-4290
Fax Number	:	401-723-4830

Provider Business Practice Location Address
First Line	:	115 NEWPORT AVE
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02861-4107
Country	:	US
Telephone Number	:	401-723-4290
Fax Number	:	401-723-4830

Authorized Official
Title or Position	:	OWNER
Name	:	PAUL T ZAYDON
Credential	:	MD
Telephone Number	:	401-723-4290

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	08/22/2020

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