Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 0101258648 | VA |
Y | 207RP1001X | Pulmonary Disease | 0101258648 | VA |
NPI | 1063671105 |
---|---|
Provider Name | Tessy K. Paul |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22908-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2008 |
Last Update Date | 10/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
557705500 | (05) | MD |
974409-01 | CAREFIRST BC/BS (01) | MD |
S062-0429 | CAREFIRST BC/BS REGIONAL (01) | MD |