MEDICARE: DR. PAUL CHARLES MCCULLOUGH MD

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	207R00000X	Internal Medicine Physician	140640-01	NY

General Provider Information

NPI Number	:	1528003654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL CHARLES MCCULLOUGH MD

Provider Business Mailing Address
First Line	:	4209 28TH ST # CN-48
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4130
Country	:	US
Telephone Number	:	347-396-6299
Fax Number	:	347-396-6367

Provider Business Practice Location Address
First Line	:	295 FLATBUSH AVENUE EXT FL 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3001
Country	:	US
Telephone Number	:	718-249-1468
Fax Number	:	718-249-1488

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	05/06/2024

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