Healthcare Provider Details

I. General information

NPI: 1700944071
Provider Name (Legal Business Name): PAUL ANTHONY ZILIOLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 CAMPBELL BLVD
BALTIMORE MD
21236-5916
US

IV. Provider business mailing address

KAISER PARMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP 2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLAINCE UNI
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 410-933-7638
  • Fax: 410-933-7802
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0029608
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: