Provider Demographics
NPI:1720030612
Name:MECHERIKUNNEL, PAUL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:THOMAS
Last Name:MECHERIKUNNEL
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:PO BOX 650580
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-0580
Mailing Address - Country:US
Mailing Address - Phone:703-435-5510
Mailing Address - Fax:703-435-3147
Practice Address - Street 1:107 E HOLLY AVE
Practice Address - Street 2:STE 3
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-5405
Practice Address - Country:US
Practice Address - Phone:703-435-5510
Practice Address - Fax:703-435-3147
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058145207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00457Medicare ID - Type Unspecified
VA200001100Medicare ID - Type Unspecified
F84075Medicare UPIN