Provider Demographics
NPI:1326043761
Name:QUESENBERRY, PAUL J (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:QUESENBERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11110 MEDICAL CAMPUS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6797
Mailing Address - Country:US
Mailing Address - Phone:301-790-9240
Mailing Address - Fax:
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 200
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6797
Practice Address - Country:US
Practice Address - Phone:301-714-4400
Practice Address - Fax:301-714-4424
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052474L207Q00000X
MDD86668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007307260034OtherMEDICAID GROUP #
PAMD052474LOtherLICENSE
PA120420409OtherDEPT OF LABOR
PA427334OtherHEALTH AMERICA
PA867633OtherMEDICARE GROUP #
PA25-1716306OtherGREATWEST HEALTHCARE
PA122756OtherUNISON
PA1336313OtherFIRST HEALTH
PA25-1716306OtherMULTIPLAN/PHCS
PA25-1716306OtherINTERGROUP
PA080087934OtherRAILROAD MEDICARE
PA2106701OtherCAPITAL BLUECROSS
PA25-1716306OtherHEALTHNET/TRICARE
PA25-1716306OtherDEVON
PA4526530OtherAETNA NON-HMO
PAP006024OtherGATEWAY
PAQU766314OtherHIGHMARK BLUESHIELD
PA0014678570003Medicaid
PA247738OtherMAMSI
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA25-1716306OtherINFORMED
PA843855OtherAETNA HMO
PA843855OtherAETNA HMO
PA25-1716306OtherMULTIPLAN/PHCS
PA867633OtherMEDICARE GROUP #