MEDICARE: KRISTEN M PIAZZA PA-C

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	363A00000X	Physician Assistant	MA060606	PA
2	363A00000X	Physician Assistant	C04839	MD

General Provider Information

NPI Number	:	1710242557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN M PIAZZA PA-C

Provider Business Mailing Address
First Line	:	900 ELKRIDGE LANDING RD FL 2
Second Line	:
City	:	LINTHICUM
State	:	MD
Zip	:	21090-2924
Country	:	US
Telephone Number	:	443-462-5010
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 OSLER DR STE 302
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-7738
Country	:	US
Telephone Number	:	410-337-1783
Fax Number	:

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

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	01/04/2024

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