Healthcare Provider Details

I. General information

NPI: 1720056955
Provider Name (Legal Business Name): PAUL ALAN BLAUNER PA-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2991 CRANBERRY HWY
EAST WAREHAM MA
02538-1354
US

IV. Provider business mailing address

535 FAUNCE CORNER RD HAWTHORN MEDICAL ASSOCIATES
DARTMOUTH MA
02747
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-3991
  • Fax:
Mailing address:
  • Phone: 508-996-3991
  • Fax: 508-985-5038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: