Provider Demographics
NPI:1851356034
Name:PAQUETTE, EDMOND LAURENT (MD)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:LAURENT
Last Name:PAQUETTE
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 1:8503 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4628
Mailing Address - Country:US
Mailing Address - Phone:703-208-4200
Mailing Address - Fax:703-876-1799
Practice Address - Street 1:8503 ARLINGTON BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4628
Practice Address - Country:US
Practice Address - Phone:703-208-4200
Practice Address - Fax:703-876-1799
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD09096208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology