Provider Demographics
NPI:1790922300
Name:PAUL A DORN JR MD PA
Entity Type:Organization
Organization Name:PAUL A DORN JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DORN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:301-423-5858
Mailing Address - Street 1:4467 OLD BRANCH AVE
Mailing Address - Street 2:STE 207
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1854
Mailing Address - Country:US
Mailing Address - Phone:301-423-5858
Mailing Address - Fax:301-423-4165
Practice Address - Street 1:4467 OLD BRANCH AVE
Practice Address - Street 2:STE 207
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1854
Practice Address - Country:US
Practice Address - Phone:301-423-5858
Practice Address - Fax:301-423-4165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD04426207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4666OtherCAREFIRST DC REGION
MD398064OtherCAREFIRST OF MD
MD398064OtherCAREFIRST OF MD