Provider Demographics
NPI:1447258363
Name:MUTO, PAULA M (MD)
Entity type:Individual
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First Name:PAULA
Middle Name:M
Last Name:MUTO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:198 MASSACHUSSETTS AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-685-5474
Mailing Address - Fax:788-820-2369
Practice Address - Street 1:100 AMESBURY ST
Practice Address - Street 2:SUITE 113
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840
Practice Address - Country:US
Practice Address - Phone:978-685-5474
Practice Address - Fax:978-689-0493
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2019-07-03
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Provider Licenses
StateLicense IDTaxonomies
MA810022086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3152464Medicaid
A21377Medicare PIN
G28958Medicare UPIN