Healthcare Provider Details

I. General information

NPI: 1063413342
Provider Name (Legal Business Name): PAUL RICHARD CAUCHON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INTERNAL MEDICINE CLINIC N.N.M.C. BLDG 19, 8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

INTERNAL MEDICINE CLINIC N.N.M.C. BLDG 19, 8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-8750
  • Fax: 301-319-4712
Mailing address:
  • Phone: 301-319-8750
  • Fax: 301-319-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC003414
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: