Basic Information
| Provider Information | |||||||||
| NPI: | 1699758896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUSTO | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 WILLARD ST | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021691281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177691162 | ||||||||
| FaxNumber: | 6177709491 | ||||||||
| Practice Location | |||||||||
| Address1: | 51 PERFORMANCE DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | WEYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021893141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177691162 | ||||||||
| FaxNumber: | 6177709491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 03/20/2017 | ||||||||
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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 | 207RH0003X | 50948 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 3008096 | 05 | MA | MEDICAID | B20041401 | 01 | MA | CIGNA | OTHER | 0027771 | 01 | MA | AETNA US HEALTH | OTHER | 705747 | 01 | MA | TUFTS HEALTH CARE | OTHER | 9241 | 01 | MA | HARVARD PILGRIM | OTHER | J02033 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER |