Provider Demographics
NPI:1992865588
Name:O'BRIEN, PAUL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOHN
Last Name:O'BRIEN
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 1:6715 LITTLE RIVER TPKE STE 300
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3546
Mailing Address - Country:US
Mailing Address - Phone:703-751-6668
Mailing Address - Fax:703-642-1049
Practice Address - Street 1:6715 LITTLE RIVER TPKE STE 300
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3546
Practice Address - Country:US
Practice Address - Phone:703-751-6668
Practice Address - Fax:703-642-1049
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055808207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010062802Medicaid
5164685OtherAETNA
J4230001OtherCAREFIRST
VAG01424C01Medicare ID - Type UnspecifiedDC METRO AREA
J4230001OtherCAREFIRST