Basic Information
| Provider Information | |||||||||
| NPI: | 1467446443 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCFADDEN | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446222058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303437950 | ||||||||
| FaxNumber: | 3303437805 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446222058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303437950 | ||||||||
| FaxNumber: | 3303437805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 04/02/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35033696M | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0346307 | 05 | OH | MEDICAID |