Individual
PAUL FREDERICK FADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
49 HARRY KEMP WAY, PROVINCETOWN, MA 02657-1618
(508) 487-9395
(508) 487-6298
Mailing address
PO BOX 598, HARWICH PORT, MA 02646-0598
(508) 905-2800
(508) 487-6298
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19986
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07630799X
STATE TAX ID NUMBER
AZ
Enumeration date
06/17/2005
Last updated
03/10/2021
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