Healthcare Provider Details

I. General information

NPI: 1497740195
Provider Name (Legal Business Name): PAUL MATTHEW DOROGHAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 FRANKLIN ST
RUMFORD ME
04276-2104
US

IV. Provider business mailing address

420 FRANKLIN ST
RUMFORD ME
04276-2104
US

V. Phone/Fax

Practice location:
  • Phone: 207-369-1106
  • Fax: 207-369-1180
Mailing address:
  • Phone: 207-369-1106
  • Fax: 207-369-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD20630
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: