Provider Demographics
NPI:1730216078
Name:CREHAN, PAUL JOSEPH (PA)
Entity type:Individual
Prefix:PROF
First Name:PAUL
Middle Name:JOSEPH
Last Name:CREHAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:37 BONAD RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3244
Mailing Address - Country:US
Mailing Address - Phone:781-826-0053
Mailing Address - Fax:
Practice Address - Street 1:92 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3800
Practice Address - Country:US
Practice Address - Phone:781-826-0053
Practice Address - Fax:781-826-0054
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ55924Medicare UPIN