Basic Information
| Provider Information | |||||||||
| NPI: | 1770582603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLAN | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5700 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049155700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664314077 | ||||||||
| FaxNumber: | 4137747448 | ||||||||
| Practice Location | |||||||||
| Address1: | 329 CONWAY ST | ||||||||
| Address2: | GREENFIELD HEALTH CENTER | ||||||||
| City: | GREENFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013011526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137746301 | ||||||||
| FaxNumber: | 4137723314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 04/19/2013 | ||||||||
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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 | 207R00000X | 221540 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 221540 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 221540 | 01 | MA | CONNECTICARE | OTHER | 99439 | 01 | MA | FALLON COMMUNITY HEALTH PLAN | OTHER | 467560 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 1979896001 | 01 | MA | CIGNA HEALTH PLANS | OTHER | 2082934 | 05 | MA | MEDICAID | 3640514 | 01 | MA | AETNA/US HEALTHCARE | OTHER | J28015 | 01 | MA | BLUE CROSS & BLUE SHIELD | OTHER | 000000028884 | 01 | MA | BOSTON MEDICAL CENTER HEALTHNET PLAN | OTHER | AA19115 | 01 | MA | HARVARD PILGRIM HEALTHCARE | OTHER | 34981 | 01 | MA | HEALTH NEW ENGLAND | OTHER |