Healthcare Provider Details

I. General information

NPI: 1700873312
Provider Name (Legal Business Name): PAUL KERRY SIMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E. THIRD ST.
WILLIAMSPORT PA
17701
US

IV. Provider business mailing address

1101 E. THIRD ST.
WILLIAMSPORT PA
17701
US

V. Phone/Fax

Practice location:
  • Phone: 570-505-3180
  • Fax: 570-505-3184
Mailing address:
  • Phone: 570-505-3180
  • Fax: 570-505-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD070363L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberMD070363L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: