Healthcare Provider Details

I. General information

NPI: 1538152574
Provider Name (Legal Business Name): PAUL P HARASIMOWICZ III M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 GROTON RD SUITE 160
AYER MA
01432-1124
US

IV. Provider business mailing address

190 GROTON RD SUITE 160
AYER MA
01432-1124
US

V. Phone/Fax

Practice location:
  • Phone: 978-772-9846
  • Fax: 978-772-1180
Mailing address:
  • Phone: 978-772-9846
  • Fax: 978-772-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number73797
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: