Provider Demographics
NPI:1174519078
Name:SIMONELLI, PAUL M (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:SIMONELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4349
Mailing Address - Country:US
Mailing Address - Phone:717-299-3077
Mailing Address - Fax:717-299-3241
Practice Address - Street 1:101 GOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4349
Practice Address - Country:US
Practice Address - Phone:717-299-3077
Practice Address - Fax:717-299-3241
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006787E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E43529Medicare UPIN