Healthcare Provider Details

I. General information

NPI: 1679034003
Provider Name (Legal Business Name): PAUL BENJAMIN WAKSMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ROUTE 6A
SANDWICH MA
02563-5309
US

IV. Provider business mailing address

130 NORTH ST STE A
HYANNIS MA
02601-3825
US

V. Phone/Fax

Practice location:
  • Phone: 508-775-8282
  • Fax: 508-775-8280
Mailing address:
  • Phone: 508-775-8282
  • Fax: 508-775-8280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA8561
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: