Provider Demographics
NPI:1104817857
Name:SAVOCA, PAUL E (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:SAVOCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:13135 LEE JACKSON MEMORIAL HWY STE 305
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1907
Practice Address - Country:US
Practice Address - Phone:703-359-8640
Practice Address - Fax:703-591-6105
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-04-21
Deactivation Date:2012-08-27
Deactivation Code:
Reactivation Date:2012-10-10
Provider Licenses
StateLicense IDTaxonomies
NY266314208C00000X
VA0101049457208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1104817857Medicaid
VA739661ZAHMedicare PIN
VAVVI940AMedicare UPIN