Provider Demographics
NPI:1326120130
Name:PAUL H WEISSHAAR MD PC
Entity Type:Organization
Organization Name:PAUL H WEISSHAAR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:HEISSHAAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-978-1777
Mailing Address - Street 1:5206 A ROLLING ROAD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015
Mailing Address - Country:US
Mailing Address - Phone:703-978-1777
Mailing Address - Fax:703-978-6093
Practice Address - Street 1:5206A ROLLING ROAD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015
Practice Address - Country:US
Practice Address - Phone:703-978-1777
Practice Address - Fax:703-978-6093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027569207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1411OtherBCBS
VA6274668Medicaid
VA023206OtherBCBS
VA023206OtherBCBS
VA6274668Medicaid