Gustafson, Paul
Gustafson, Paul is an individual health care provider with primary practice located at 398 Neponset Ave , Dorchester MA 02122-3134. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Gustafson, Paul can be contacted via phone (617) 282-3200.Contact Information
Primary practice address
398 Neponset Ave
Dorchester MA 02122-3134
Phone: (617) 282-3200
Fax: (617) 282-8201
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 41092 | Massachusetts |
Profile Details
| NPI number | 1811972797 |
|---|---|
| LBN Legal business name | Gustafson, Paul |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 13th, 2005 |
| Last updated | Feb 4th, 2013 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1811972797 | NPPES |
| Massachusetts | MEDICAID | 2052792 |
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