Provider Demographics
NPI:1306929625
Name:THESIGER, PAUL STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEPHEN
Last Name:THESIGER
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 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1135
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-951-8122
Mailing Address - Fax:301-951-8128
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1135
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-951-8122
Practice Address - Fax:301-951-8128
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063922174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7153742OtherAETNA PROVIDER ID NUMBER
MDI05339Medicare UPIN