Healthcare Provider Details

I. General information

NPI: 1962568402
Provider Name (Legal Business Name): THERESA MICHELE KOESTER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 NEW MEXICO AVE NW, SUITE 206 JHCP SURGERY FOXHALL
WASHINGTON DC
20016-3622
US

IV. Provider business mailing address

3100 WYMAN PARK DR JHCP BUSINESS OFFICE
BALTIMORE MD
21211-2803
US

V. Phone/Fax

Practice location:
  • Phone: 202-895-1440
  • Fax: 202-895-1448
Mailing address:
  • Phone: 410-338-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA030436
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: