Healthcare Provider Details

I. General information

NPI: 1366728438
Provider Name (Legal Business Name): MICHAEL VINCENT KNEFEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8830 BELAIR RD
BALTIMORE MD
21236-2401
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 410-529-9200
  • Fax:
Mailing address:
  • Phone: 804-968-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0004625
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: