Basic Information
| Provider Information | |||||||||
| NPI: | 1245299445 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIERNAN | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2921 TELESTAR CT | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220421205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032805858 | ||||||||
| FaxNumber: | 7032802654 | ||||||||
| Practice Location | |||||||||
| Address1: | 2921 TELESTAR CT | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220421205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032805858 | ||||||||
| FaxNumber: | 7032802654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 12/06/2007 | ||||||||
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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 | 174400000X | 0101034326 | VA | N | Other Service Providers | Specialist | 208G00000X | 0101034326 | VA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208600000X | 0101034326 | VA | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7305206 | 05 | VA | MEDICAID | 0214234000 | 05 | WV | MEDICAID | 269281300 | 05 | MD | MEDICAID | 031186900 | 05 | DC | MEDICAID |