Provider Demographics
NPI:1346357936
Name:PAULSON, JILL MIRIAM (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MIRIAM
Last Name:PAULSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 WILSON BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-3866
Mailing Address - Country:US
Mailing Address - Phone:571-999-7973
Mailing Address - Fax:703-952-1404
Practice Address - Street 1:3033 WILSON BLVD STE 410
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-3866
Practice Address - Country:US
Practice Address - Phone:703-260-6105
Practice Address - Fax:844-344-2173
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0074848207RE0101X
DCMD042041207RE0101X
VA101272577207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD26404Medicare PIN