Provider Demographics
NPI:1265604870
Name:PAO, VIVIAN Y (MD)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:Y
Last Name:PAO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 TEXAS STATION CT
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-8286
Mailing Address - Country:US
Mailing Address - Phone:410-828-7417
Mailing Address - Fax:410-828-4695
Practice Address - Street 1:1 TEXAS STATION CT
Practice Address - Street 2:SUITE 300
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-8286
Practice Address - Country:US
Practice Address - Phone:410-828-7417
Practice Address - Fax:410-828-4695
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA85813207RE0101X
MDD68920207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD422155900Medicaid