Basic Information
| Provider Information | |||||||||
| NPI: | 1548219637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONACH | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 375 BOYLSTON ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024456007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8573070896 | ||||||||
| FaxNumber: | 8573070899 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 ALBANY STREET | ||||||||
| Address2: | SHAPIRO 7, SUITE B | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176387460 | ||||||||
| FaxNumber: | 6176385226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2018 | ||||||||
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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 | 213651 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RR0500X | 213651 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 110040601A | 05 | MA | MEDICAID |