Provider Demographics
NPI:1033194048
Name:D'AMBROSIO, PAUL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:D'AMBROSIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2284 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3829
Mailing Address - Country:US
Mailing Address - Phone:978-369-5575
Mailing Address - Fax:978-371-9189
Practice Address - Street 1:2284 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3829
Practice Address - Country:US
Practice Address - Phone:978-369-5575
Practice Address - Fax:978-371-9189
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73162207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3083004Medicaid
MAJ11066OtherBLUE CROSS
MA071362OtherTUFTS HEALTH PLAN
MA60305OtherHARVARD PILGRIM
MA071362OtherTUFTS HEALTH PLAN
MA60305OtherHARVARD PILGRIM
MAJ11066Medicare ID - Type Unspecified
MAE84804Medicare UPIN