Healthcare Provider Details

I. General information

NPI: 1659371888
Provider Name (Legal Business Name): KINGA MICHELLE HUZELLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CHAMPION DR SUITE 100
HAGERSTOWN MD
21740-6558
US

IV. Provider business mailing address

220 CHAMPION DR SUITE 100
HAGERSTOWN MD
21740-6558
US

V. Phone/Fax

Practice location:
  • Phone: 301-791-0888
  • Fax: 301-791-3611
Mailing address:
  • Phone: 301-791-0888
  • Fax: 301-791-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0053753
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: