Provider Demographics
NPI:1275535981
Name:PRITCHETT SR, PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:PRITCHETT SR
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 1:118 LAGRANGE AVE
Mailing Address - Street 2:PO BOX 1317
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-9591
Mailing Address - Country:US
Mailing Address - Phone:301-934-3626
Mailing Address - Fax:
Practice Address - Street 1:118 LAGRANGE AVE
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-9591
Practice Address - Country:US
Practice Address - Phone:301-934-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0008370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC66710001OtherBC/BS OF DC
MD0100344OtherUNITED HEALTHCARE
MD34732501OtherBC BS OF MD
MD0100344OtherUNITED HEALTHCARE
MD34732501OtherBC BS OF MD
DC408445Medicare ID - Type Unspecified