Healthcare Provider Details

I. General information

NPI: 1699843466
Provider Name (Legal Business Name): PAUL CIMINERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE NW WALTER REED ARMY MEDICAL CENTER
WASHINGTON, DC DC
20307-5001
US

IV. Provider business mailing address

1001 BILTMORE AVE
WEST RIVER MD
20778-2223
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-0471
  • Fax:
Mailing address:
  • Phone: 410-867-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberD0059176
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: