Basic Information
| Provider Information | |||||||||
| NPI: | 1366464257 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN ZIJL | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | SEAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 CROSSROADS DR | ||||||||
| Address2: | STE 306 | ||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211175421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437388163 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 PLUMTREE RD | ||||||||
| Address2: | STE 210 | ||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210156053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108030089 | ||||||||
| FaxNumber: | 4108030251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2006 | ||||||||
| LastUpdateDate: | 04/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | D61244 | MD | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 276600100 | 05 | MD | MEDICAID | E279 | 01 | DC | CAREFIRST | OTHER | KJ62 | 01 | MD | CAREFIRST | OTHER |