Healthcare Provider Details

I. General information

NPI: 1699766972
Provider Name (Legal Business Name): KRISTINE B PACE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW RM 4B42
WASHINGTON DC
20010-2976
US

IV. Provider business mailing address

1201 SEVEN LOCKS RD SUITE 200
ROCKVILLE MD
20854-2931
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-7259
  • Fax: 202-877-7258
Mailing address:
  • Phone: 301-652-5771
  • Fax: 301-652-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA30218
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: