Provider Demographics
NPI:1740280601
Name:DURR, PAUL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DURR
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 1:130 PARK ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4626
Mailing Address - Country:US
Mailing Address - Phone:703-938-7800
Mailing Address - Fax:703-938-4541
Practice Address - Street 1:130 PARK ST SE STE 200
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4626
Practice Address - Country:US
Practice Address - Phone:703-938-7800
Practice Address - Fax:703-938-4541
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5880742Medicaid
VA00B209T02Medicare PIN
IN5880742Medicaid