Healthcare Provider Details

I. General information

NPI: 1083661094
Provider Name (Legal Business Name): PAUL L BARON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 05/01/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 64TH ST FL 3
NEW YORK NY
10065-7471
US

IV. Provider business mailing address

210 E 64TH ST FL 3
NEW YORK NY
10065-7471
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-6900
  • Fax: 212-434-6950
Mailing address:
  • Phone: 843-324-7137
  • Fax: 849-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number14892
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number14892
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: