Healthcare Provider Details

I. General information

NPI: 1134152416
Provider Name (Legal Business Name): PAULINE HSU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BAUGHMANS LN SECOND FLOOR
FREDERICK MD
21702-4059
US

IV. Provider business mailing address

9706 STARLING RD
ELLICOTT CITY MD
21042-1775
US

V. Phone/Fax

Practice location:
  • Phone: 304-846-0300
  • Fax: 301-663-6048
Mailing address:
  • Phone: 410-418-5295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0053595
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: