MEDICARE: MS. CAROL L KNIOLA PAC

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	C01503	MD

General Provider Information

NPI Number	:	1730290297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL L KNIOLA PAC

Provider Business Mailing Address
First Line	:	3500 BOSTON ST STE J1
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-5723
Country	:	US
Telephone Number	:	410-522-0001
Fax Number	:	410-522-0017

Provider Business Practice Location Address
First Line	:	3500 BOSTON ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-5251
Country	:	US
Telephone Number	:	410-522-0001
Fax Number	:	410-522-0017

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/06/2019

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Directions to “ MS. CAROL L KNIOLA PAC” Practice Location

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