Healthcare Provider Details

I. General information

NPI: 1538149299
Provider Name (Legal Business Name): MICHAEL J PARIS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 FAME AVE SUITE 220
HANOVER PA
17331-1587
US

IV. Provider business mailing address

250 FAME AVE SUITE 220
HANOVER PA
17331-1587
US

V. Phone/Fax

Practice location:
  • Phone: 717-632-5264
  • Fax: 717-632-1165
Mailing address:
  • Phone: 717-632-5264
  • Fax: 717-632-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC004734L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: