MEDICARE: PAUL V. TARGONSKI M.D., PH.D.

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	207R00000X	Internal Medicine Physician	0101255756	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110222467	OTHER	MN	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922085406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL V. TARGONSKI M.D., PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 9007
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22906-9007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 JEFFERSON PARK AVE
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22903-3410
Country	:	US
Telephone Number	:	434-924-1931
Fax Number	:	434-244-4451

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	11/03/2020

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