Provider Demographics
NPI:1649316969
Name:PAUL P. HARASIMOWICZ,III,M.D.,P.C.
Entity type:Organization
Organization Name:PAUL P. HARASIMOWICZ,III,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARASIMOWICZ
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:978-772-9846
Mailing Address - Street 1:190 GROTON RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-1124
Mailing Address - Country:US
Mailing Address - Phone:978-772-9846
Mailing Address - Fax:978-772-1180
Practice Address - Street 1:190 GROTON RD
Practice Address - Street 2:SUITE 160
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432-1124
Practice Address - Country:US
Practice Address - Phone:978-772-9846
Practice Address - Fax:978-772-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73797174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA073797OtherTUFTS
MA9779612Medicaid
MAJ11220OtherBCBS
MA3078272Medicaid
MAJ11220Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
MAE86638Medicare UPIN
MA3078272Medicaid