Provider Demographics
NPI:1205842002
Name:PRUNIER, PAUL GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GEORGE
Last Name:PRUNIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 WILLARD AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4607
Mailing Address - Country:US
Mailing Address - Phone:301-656-2767
Mailing Address - Fax:301-656-7423
Practice Address - Street 1:4701 WILLARD AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4607
Practice Address - Country:US
Practice Address - Phone:301-656-2767
Practice Address - Fax:301-656-7423
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00332462084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01091Medicare UPIN
MD653944Medicare ID - Type Unspecified