Provider Demographics
NPI:1740696186
Name:TYAN, PAUL
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:TYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:013-408-3393
Mailing Address - Fax:
Practice Address - Street 1:19450 DEERFIELD AVE STE 460
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6840
Practice Address - Country:US
Practice Address - Phone:571-707-8522
Practice Address - Fax:571-707-8577
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101269434207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program