Provider Demographics
NPI:1942391693
Name:PAUL A. DEVORE MD PC
Entity Type:Organization
Organization Name:PAUL A. DEVORE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEVORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-454-0801
Mailing Address - Street 1:4203 QUEENSBURY RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1435
Mailing Address - Country:US
Mailing Address - Phone:301-454-0801
Mailing Address - Fax:301-454-0810
Practice Address - Street 1:4203 QUEENSBURY RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-1435
Practice Address - Country:US
Practice Address - Phone:301-454-0801
Practice Address - Fax:301-454-0810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD001852207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB92880Medicare UPIN
DCG02221Medicare PIN
MD310PMedicare PIN