Provider Demographics
NPI:1700875986
Name:PAULUS, RICHARD E (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:PAULUS
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:PO BOX 2380
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2380
Mailing Address - Country:US
Mailing Address - Phone:606-324-4745
Mailing Address - Fax:606-326-0165
Practice Address - Street 1:613 23RD ST
Practice Address - Street 2:STE 230
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2876
Practice Address - Country:US
Practice Address - Phone:606-324-4745
Practice Address - Fax:606-326-0165
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29247207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64002470Medicaid
KY000000049963OtherANTHEM BLUECROSS & BLUESH
WV000733000OtherMT STATE BCBS
WV0086372000Medicaid
OH0906416Medicaid
KY0257201Medicare PIN
WV0086372000Medicaid
KY64002470Medicaid
OH0906416Medicaid
OHP00680105Medicare PIN
KY00788013Medicare PIN
OH0879081Medicare PIN