=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851356133
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL J AMOROSO MD, MPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2006
-----------------------------------------------------
Last Update Date | 10/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CREDENTENTIALS OFFICE MADIGAN ARMY MEDICAL CTR 9040 FITZSIMONS DRIVE, ATTN: MCHJ-CI
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98431-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-968-1160
-----------------------------------------------------
Fax | 253-399-2882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9040 FITZSIMONS DRIVE, ATTN: MCHJ-CI CREDENTENTIAL'S OFFICE, MADIGAN ARMY MEDICAL CENTER
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-968-1160
-----------------------------------------------------
Fax | 253-399-2882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083A0100X
-----------------------------------------------------
Taxonomy Name | Aerospace Medicine Physician
-----------------------------------------------------
License Number | 56723
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------