Healthcare Provider Details

I. General information

NPI: 1992584924
Provider Name (Legal Business Name): KUM THERESIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11720 BELTSVILLE DR # 500A15
BELTSVILLE MD
20705-3166
US

IV. Provider business mailing address

11720 BELTSVILLE DR # 500A15
BELTSVILLE MD
20705-3166
US

V. Phone/Fax

Practice location:
  • Phone: 202-790-8903
  • Fax: 301-889-9735
Mailing address:
  • Phone: 202-790-8903
  • Fax: 301-889-9735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: