Provider Demographics
NPI:1962638288
Name:PAO, MARYLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYLAND
Middle Name:
Last Name:PAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTER DRIVE
Mailing Address - Street 2:BUILDING 10 CRC 6-5340 MSC 1276
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-1276
Mailing Address - Country:US
Mailing Address - Phone:301-435-5770
Mailing Address - Fax:301-402-2588
Practice Address - Street 1:10 CENTER DR
Practice Address - Street 2:BUILDING 10 CRC 6-5340 MSC 1276
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-435-5770
Practice Address - Fax:301-402-2588
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD372592084P0015X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry