Provider Demographics
NPI:1548274012
Name:PAULINO, GERARDO B (MD)
Entity type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:B
Last Name:PAULINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 799
Mailing Address - Street 2:21 COLLETTE RD
Mailing Address - City:FISKDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01518-1172
Mailing Address - Country:US
Mailing Address - Phone:508-347-0906
Mailing Address - Fax:
Practice Address - Street 1:85 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WARE
Practice Address - State:MA
Practice Address - Zip Code:01082
Practice Address - Country:US
Practice Address - Phone:413-967-2272
Practice Address - Fax:413-967-2330
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA373012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA2026562Medicaid
MAMA2026562Medicaid