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NPI Code Detail

MEDICARE: PAUL R CLARK

MEDICARE: PAUL R CLARK
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
1332BC3200XCustomized Equipment (DME)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1670375OTHERMATUFT'S NAVIGATOR
2670375OTHERMATUFT'S HEALTH INSURANCE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4375354OTHERMABLUE CROSS/BLUE SHIELD OF MASSACHUSETTS
5670375OTHERMATUFT'S TOTAL HEALTH PLAN

General Provider Information

NPI Number : 1851577795
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAUL R CLARK
Provider Business Mailing Address
First Line : P O BOX 850164
Second Line :
City : BRAINTREE
State : MA
Zip : 02185
Country : US
Telephone Number : 617-787-0504
Fax Number :
Provider Business Practice Location Address
First Line : 1 BRAINTREE ST
Second Line :
City : ALLSTON
State : MA
Zip : 02134-1602
Country : US
Telephone Number : 617-787-0504
Fax Number : 781-356-2074
Authorized Official
Title or Position : ORTHOTIST
Name : MR. PAUL R. CLARK
Credential :
Telephone Number : 617-787-0504
Provider Enumeration Date : 01/10/2008
Last Update Date : 10/29/2010

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Directions to “PAUL R CLARK ” Practice Location

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