Healthcare Provider Details

I. General information

NPI: 1609848076
Provider Name (Legal Business Name): ERIC PUCCINI PAULSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MONTVALE AVE STE 200
STONEHAM MA
02180-2445
US

IV. Provider business mailing address

41 MONTVALE AVE STE 200
STONEHAM MA
02180-2445
US

V. Phone/Fax

Practice location:
  • Phone: 781-279-0971
  • Fax: 617-573-5646
Mailing address:
  • Phone: 781-279-0971
  • Fax: 617-573-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number1021604
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: