Healthcare Provider Details

I. General information

NPI: 1871756999
Provider Name (Legal Business Name): TANIA PAUL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 MIDLAND RD
SOUTHERN PINES NC
28387-2927
US

IV. Provider business mailing address

2170 MIDLAND RD
SOUTHERN PINES NC
28387-2927
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-2100
  • Fax: 910-295-0917
Mailing address:
  • Phone: 910-295-2100
  • Fax: 910-295-0917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberP51083
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: