Healthcare Provider Details

I. General information

NPI: 1962446765
Provider Name (Legal Business Name): PAUL L ASDOURIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 NORTH CALVERT STREET SUITE 400
BALTIMORE MD
21218
US

IV. Provider business mailing address

3333 NORTH CALVERT STREET SUITE 400
BALTIMORE MD
21218
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-2270
  • Fax: 410-261-2726
Mailing address:
  • Phone: 410-554-2270
  • Fax: 410-261-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD35332
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: