Provider Demographics
NPI:1821058348
Name:KURYLA, PAUL TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:TIMOTHY
Last Name:KURYLA
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 1:4605 MACCORKLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1311
Mailing Address - Country:US
Mailing Address - Phone:304-414-4800
Mailing Address - Fax:
Practice Address - Street 1:400 DIVISION ST STE 6
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1459
Practice Address - Country:US
Practice Address - Phone:304-414-4863
Practice Address - Fax:304-414-4864
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVB441OtherGROUP MEDICARE
WV3810024049OtherGROUP MEDICAID
WV0042482000Medicaid
WVWV6030B441Medicare PIN
WV0042482000Medicaid
WV0042482000Medicaid