Healthcare Provider Details

I. General information

NPI: 1871827097
Provider Name (Legal Business Name): KATHY ELIZABETH OZDINEC PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHY ELIZABETH KUSS PA-C

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK RD DCH /OR
LANHAM MD
20706-3574
US

IV. Provider business mailing address

8118 GOOD LUCK RD DCH /OR
LANHAM MD
20706-3574
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-8500
  • Fax: 301-552-8135
Mailing address:
  • Phone: 301-552-8500
  • Fax: 301-552-8135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC0001423
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: