Provider Demographics
NPI:1134187651
Name:KOERNER, PAUL A (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:KOERNER
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 1:300 BIRNIE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1107
Mailing Address - Country:US
Mailing Address - Phone:413-785-4666
Mailing Address - Fax:413-846-4756
Practice Address - Street 1:300 BIRNIE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1107
Practice Address - Country:US
Practice Address - Phone:413-785-4666
Practice Address - Fax:413-846-4756
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72132207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C49422Medicare UPIN
NX2007Medicare PIN
200045341OtherRR MEDICARE
AK8792651OtherDEA
4342380OtherUS HEALTHCARE
C49422Medicare UPIN
0023176OtherNEIGHBORHOOD H
1806991004OtherCIGNA
13647OtherHNE
072132OtherTUFTS
4342380OtherAETNA
484619 H943OtherCONNECTICARE
72132OtherLIC
000000025104OtherHEALTH NET
3065791OtherMASSHEALTH
J09337OtherBLUE SHIELD
J09337OtherHMO BLUE
J09337Medicare ID - Type Unspecified
MA3065791Medicaid