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NPI Code Detail

MEDICARE: DR. PAUL DAVID D'AMBROSIO M.D.

MEDICARE: DR. PAUL DAVID D'AMBROSIO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician73162MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2J11066OTHERMABLUE CROSS
3071362OTHERMATUFTS HEALTH PLAN
460305OTHERMAHARVARD PILGRIM

General Provider Information

NPI Number : 1033194048
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAUL DAVID D'AMBROSIO M.D.
Provider Business Mailing Address
First Line : 2284 MAIN ST
Second Line :
City : CONCORD
State : MA
Zip : 01742-3829
Country : US
Telephone Number : 978-369-5575
Fax Number : 978-371-9189
Provider Business Practice Location Address
First Line : 2284 MAIN ST
Second Line :
City : CONCORD
State : MA
Zip : 01742-3829
Country : US
Telephone Number : 978-369-5575
Fax Number : 978-371-9189
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 01/21/2014

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1316243587 — MR. RICHARD KEVIN HENEGHAN JR. RNNP
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