Provider Demographics
NPI:1790929990
Name:PAUL C DESPER MD
Entity Type:Organization
Organization Name:PAUL C DESPER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:DESPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-361-7121
Mailing Address - Street 1:9608 CHAMPION CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4402
Mailing Address - Country:US
Mailing Address - Phone:703-361-7121
Mailing Address - Fax:
Practice Address - Street 1:9608 CHAMPION CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4402
Practice Address - Country:US
Practice Address - Phone:703-361-7121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty