MEDICARE: DR. SVETLANA PAUL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	D0099109	MD
3	208D00000X	General Practice Physician	D0099109	MD

General Provider Information

NPI Number	:	1770112906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SVETLANA PAUL MD

Provider Business Mailing Address
First Line	:	6310 STEVENS FOREST RD STE 200
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-1036
Country	:	US
Telephone Number	:	301-454-9398
Fax Number	:

Provider Business Practice Location Address
First Line	:	6310 STEVENS FOREST RD STE 200
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-1036
Country	:	US
Telephone Number	:	301-454-9398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2020
Last Update Date	:	08/06/2024

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