Provider Demographics
NPI:1235347568
Name:PAULUS, MARY G (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:G
Last Name:PAULUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:FRANKLIN
Other - Last Name:GUTHRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:19185 EBENEZER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ROUND HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20141-1910
Mailing Address - Country:US
Mailing Address - Phone:540-554-8283
Mailing Address - Fax:540-554-8283
Practice Address - Street 1:19185 EBENEZER CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROUND HILL
Practice Address - State:VA
Practice Address - Zip Code:20141-1910
Practice Address - Country:US
Practice Address - Phone:540-554-8283
Practice Address - Fax:540-554-8283
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22855207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA01948Medicare UPIN