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NPI Code Detail

MEDICARE: KATEY LYNN CRESSY PAC

MEDICARE: KATEY LYNN CRESSY 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
1363AM0700XMedical Physician AssistantC0002356MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C0002356OTHERMDSTATE LICENSE

General Provider Information

NPI Number : 1811997950
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATEY LYNN CRESSY PAC
Provider Business Mailing Address
First Line : 9815 MAIN STREET
Second Line : SUITE 208
City : DAMASCUS
State : MD
Zip : 20872-2002
Country : US
Telephone Number : 301-253-4004
Fax Number : 301-253-3391
Provider Business Practice Location Address
First Line : 9815 MAIN STREET
Second Line : SUITE 208
City : DAMASCUS
State : MD
Zip : 20872-2002
Country : US
Telephone Number : 301-253-4004
Fax Number : 301-253-3391
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 09/09/2015

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Directions to “ KATEY LYNN CRESSY PAC” Practice Location

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