Healthcare Provider Details

I. General information

NPI: 1902665177
Provider Name (Legal Business Name): KEEGAN PAULSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

8901 WISCONSIN AVE
BETHESDA MD
20889-0004
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4900
  • Fax:
Mailing address:
  • Phone: 301-295-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101287186
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: