Healthcare Provider Details

I. General information

NPI: 1932226032
Provider Name (Legal Business Name): PATRICIA ELLEN KAPUNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE NW DEPARTMENT OF PEDIATRICS WALTER REED AMC
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

3100 SCHOFIELD ROAD, BLDG 1178 FORT SAM HOUSTON ADOLESCENT MEDICINE CLINIC
FORT SAM HOUSTON TX
78234-6400
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-6101
  • Fax:
Mailing address:
  • Phone: 210-808-2370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101242574
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: