Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 22855 | IA |
NPI | 1235347568 |
---|---|
Provider Name | Mary G. Paulus |
First Address | Round Hill, VA 20141-1910 |
Second Address | Round Hill, VA 20141-1910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 12/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A01948 | (02) | IA |