Healthcare Provider Details

I. General information

NPI: 1902275514
Provider Name (Legal Business Name): PAUL PLOURDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 GROUND HOG COLLEGE RD
WEST CHESTER PA
19382-6761
US

IV. Provider business mailing address

410 GROUND HOG COLLEGE RD
WEST CHESTER PA
19382-6761
US

V. Phone/Fax

Practice location:
  • Phone: 610-793-9776
  • Fax:
Mailing address:
  • Phone: 610-793-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number002060
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: