MEDICARE: STEPHEN E PAUL DO PA

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	207Q00000X	Family Medicine Physician	25MB02548900	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080169223	OTHER	NJ	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1841450616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN E PAUL DO PA

Provider Business Mailing Address
First Line	:	111 E MAIN ST
Second Line	:
City	:	MAPLE SHADE
State	:	NJ
Zip	:	08052-2679
Country	:	US
Telephone Number	:	856-779-9220
Fax Number	:	856-779-7890

Provider Business Practice Location Address
First Line	:	111 E MAIN ST
Second Line	:
City	:	MAPLE SHADE
State	:	NJ
Zip	:	08052-2679
Country	:	US
Telephone Number	:	856-779-9220
Fax Number	:	856-779-7890

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN E. PAUL
Credential	:	D.O.
Telephone Number	:	856-779-9220

Provider Enumeration Date	:	06/14/2008
Last Update Date	:	08/13/2008

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Directions to “STEPHEN E PAUL DO PA ” Practice Location

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