MEDICARE: PAULA BU 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
1	2084P0800X	Psychiatry Physician	295874	NY
2	2084P0800X	Psychiatry Physician	25MA11156500	NJ
3	2084P0800X	Psychiatry Physician	MD473745	PA

General Provider Information

NPI Number	:	1366973125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA BU M.D.

Provider Business Mailing Address
First Line	:	1528 WALNUT ST STE 1414
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1528 WALNUT ST STE 1414
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3610
Country	:	US
Telephone Number	:	267-845-4076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	08/06/2024

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