Provider Demographics
NPI:1780902981
Name:WILSON, PAULINA G (MD)
Entity type:Individual
Prefix:DR
First Name:PAULINA
Middle Name:G
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAULINA
Other - Middle Name:
Other - Last Name:GORNEY BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1099 22ND ST NW APT 304
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1822
Mailing Address - Country:US
Mailing Address - Phone:240-462-7539
Mailing Address - Fax:
Practice Address - Street 1:8081 INNOVATION PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4867
Practice Address - Country:US
Practice Address - Phone:571-472-7040
Practice Address - Fax:571-472-7041
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101257996208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty