Basic Information
| Provider Information | |||||||||
| NPI: | 1629015094 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIRITSIS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 BOULDERS PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232254067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045605595 | ||||||||
| FaxNumber: | 8045609029 | ||||||||
| Practice Location | |||||||||
| Address1: | 13700 SAINT FRANCIS BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | MIDLOTHIAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231143267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043792414 | ||||||||
| FaxNumber: | 8043792413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | 101053625 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207X00000X | 0101053625 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 194785 | 01 | VA | ANTHEM WEST END OPERATORY | OTHER | 540885859 | 01 | VA | C&O EMPLOYEE'S HEALTHCARE | OTHER | 6400418 | 05 | VA | MEDICAID | 2138281 | 01 | VA | UNITED HEALTHCARE MAMSI | OTHER | 540885859 | 01 | VA | COMPMANAGEMENT | OTHER | 540885859 | 01 | VA | CIGNA | OTHER | 540885859 | 01 | VA | CORVEL | OTHER | 0900927 | 01 | VA | UNITED HEALTHCARE | OTHER | 2366163 | 01 | VA | AETNA HMO | OTHER | 174628 | 01 | VA | ANTHEM HEALTHKEEPERS | OTHER | 200039105 | 01 | VA | RAILROAD MEDICARE | OTHER | 1629015094 | 05 | VA | MEDICAID | 33398 | 01 | VA | SH CARENET | OTHER | 289325 | 01 | VA | SOUTHERN HEALTH | OTHER | 36596 | 01 | VA | OPTIMA HEALTH | OTHER | 540885859 | 01 | VA | FIRST HEALTH/CCN | OTHER | 540885859 | 01 | VA | PRIVATE HEALTHCARE SYSTEM | OTHER | 540885859 | 01 | VA | FOCUS | OTHER |