Healthcare Provider Details

I. General information

NPI: 1740530203
Provider Name (Legal Business Name): MICHELLE MARIE PLEWES KOTWAS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 76TH AVENUE
LANDOVER HILLS MD
20784
US

IV. Provider business mailing address

5301 76TH AVENUE
LANDOVER HILLS MD
20784
US

V. Phone/Fax

Practice location:
  • Phone: 301-459-2121
  • Fax:
Mailing address:
  • Phone: 301-459-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number18069
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: