Provider Demographics
NPI:1174116008
Name:CURTIS, PAUL ANDRE
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDRE
Last Name:CURTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10547 JASON LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2212
Mailing Address - Country:US
Mailing Address - Phone:141-030-0164
Mailing Address - Fax:
Practice Address - Street 1:10547 JASON LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2212
Practice Address - Country:US
Practice Address - Phone:141-030-0164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program