Provider Demographics
NPI:1679524169
Name:DWORKIN, PAUL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DWORKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2546 BALLTOWN RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1079
Mailing Address - Country:US
Mailing Address - Phone:518-377-8198
Mailing Address - Fax:518-377-0620
Practice Address - Street 1:2546 BALLTOWN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1079
Practice Address - Country:US
Practice Address - Phone:518-377-8198
Practice Address - Fax:518-377-0620
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY136742207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB82164Medicare UPIN
NY52023GMedicare PIN