Provider Demographics
NPI:1962446765
Name:ASDOURIAN, PAUL L (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:ASDOURIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 NORTH CALVERT STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:410-554-2270
Mailing Address - Fax:410-261-2726
Practice Address - Street 1:3333 NORTH CALVERT STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218
Practice Address - Country:US
Practice Address - Phone:410-554-2270
Practice Address - Fax:410-261-2726
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD35332207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD903AOtherCFBCBS MD
MD41040006OtherBCBS
MD87636Medicaid
MDJ848OtherCF BCBS DC
MDJ848OtherCF BCBS DC
MD112NMedicare PIN
MD520591685OtherTIN