Provider Demographics
NPI:1053405688
Name:MODLINGER, PAUL STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEVEN
Last Name:MODLINGER
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 1:3930 WALNUT STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4738
Mailing Address - Country:US
Mailing Address - Phone:703-246-9246
Mailing Address - Fax:703-246-9257
Practice Address - Street 1:3930 WALNUT STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4738
Practice Address - Country:US
Practice Address - Phone:703-246-9246
Practice Address - Fax:703-246-9257
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236049207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010083770Medicaid
VA010085811Medicaid
VA010184983Medicaid
VA010085918Medicaid
VA010085683Medicaid
VA010085837Medicaid
VA010085691Medicaid
VA010085829Medicaid
VA010085934Medicaid
VA010124743Medicaid
9202002OtherCIGNA
47430007OtherCAREFIRST
VA010083753Medicaid
VA010085845Medicaid
2128905OtherMAMSI
VA010085721Medicaid
VA010085870Medicaid
47430007OtherCAREFIRST
VA010085918Medicaid