Healthcare Provider Details

I. General information

NPI: 1730289620
Provider Name (Legal Business Name): CARL DAVID PAULI D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E MAIN ST
PALMYRA PA
17078-1743
US

IV. Provider business mailing address

220 E MAIN ST
PALMYRA PA
17078-1743
US

V. Phone/Fax

Practice location:
  • Phone: 717-838-2151
  • Fax: 717-838-2148
Mailing address:
  • Phone: 717-838-2151
  • Fax: 717-838-2148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC001721Y
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: