Provider Demographics
NPI:1417947953
Name:MEISSNER, PAUL JOSEPH JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:MEISSNER
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 RIDGLAND RD
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2715
Mailing Address - Country:US
Mailing Address - Phone:410-666-3338
Mailing Address - Fax:410-666-3877
Practice Address - Street 1:10400 RIDGLAND RD
Practice Address - Street 2:SUITE 3
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2715
Practice Address - Country:US
Practice Address - Phone:410-666-3338
Practice Address - Fax:410-666-3877
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00556213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6531770001OtherPTAN
MDT59834Medicare UPIN