MEDICARE: JASON KOONTZ M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	110495	NC
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	110495	NC

General Provider Information

NPI Number	:	1386817104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON KOONTZ M.D., PH.D.

Provider Business Mailing Address
First Line	:	3919 STERLING RIDGE LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-5459
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 ERWIN RD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27710-5459
Country	:	US
Telephone Number	:	919-970-6452
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2008
Last Update Date	:	08/06/2025

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