Basic Information
| Provider Information | |||||||||
| NPI: | 1063579886 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUSCO | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 706 | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032640706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149890300 | ||||||||
| FaxNumber: | 6032382163 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 BOULDER POINT DRIVE | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032643168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035361284 | ||||||||
| FaxNumber: | 6035363136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 12/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MD07090 | RI | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 17272 | NH | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 180005429 | 01 | RAILROAD MEDICARE | OTHER | 2443-5 | 01 | RI | BLUE CROSS BLUE SHIELD | OTHER | 202101 | 01 | RI | BLUECHIP | OTHER | 08-001055 | 01 | UNITED HEALTHCARE | OTHER | AM3073400 | 01 | DEA | OTHER | MD07090 | 01 | RI | RI MEDICAL LICENSE | OTHER | 9002443 | 05 | RI | MEDICAID |