MEDICARE: DR. PAUL D. SANDERSON PH.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	103T00000X	Psychologist	2089	MA

General Provider Information

NPI Number	:	1457393563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL D. SANDERSON PH.D.

Provider Business Mailing Address
First Line	:	2 LIBERTY ST
Second Line	:
City	:	FOXBOROUGH
State	:	MA
Zip	:	02035-2438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 LIBERTY ST
Second Line	:
City	:	FOXBOROUGH
State	:	MA
Zip	:	02035-2438
Country	:	US
Telephone Number	:	508-543-7160
Fax Number	:

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/08/2007

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