Individual
DR. PAUL MOBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
99 E STATE ST, GLOVERSVILLE, NY 12078-1203
(518) 773-5559
(518) 773-5601
Mailing address
99 E STATE ST, PO BOX 1250, GLOVERSVILLE, NY 12078-1203
(518) 773-5559
(518) 773-5601
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
171890-1
NY
207LP2900X
Pain Medicine (Anesthesiology) Physician
171890
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000406860004
BLUE SHIELD OF NORTHEASTERN NY
NY
05
—
01611123
—
NY
01
—
10001397
CDPHP
—
01
—
3006027
MVP HEALTHPLAN
NY
Enumeration date
07/13/2006
Last updated
01/21/2015
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