Provider Demographics
NPI:1104815794
Name:GAVARIS, PAUL T (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:GAVARIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4910 MASSACHUSETTS AVE NW
Mailing Address - Street 2:STE 21
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4300
Mailing Address - Country:US
Mailing Address - Phone:202-686-0239
Mailing Address - Fax:202-686-0925
Practice Address - Street 1:4910 MASSACHUSETTS AVE NW
Practice Address - Street 2:STE 21
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4300
Practice Address - Country:US
Practice Address - Phone:202-686-0239
Practice Address - Fax:202-686-0925
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD4319207W00000X
VA0101022547207W00000X
MDD0017297207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
409071Medicare ID - Type Unspecified
B92787Medicare UPIN