Healthcare Provider Details

I. General information

NPI: 1205168770
Provider Name (Legal Business Name): MICHELE EMORY KOCZMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE EMORY PA

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 JAMES MADISON HWY STE 104
CULPEPER VA
22701-2361
US

IV. Provider business mailing address

451 JAMES MADISON HWY STE 104
CULPEPER VA
22701-2361
US

V. Phone/Fax

Practice location:
  • Phone: 540-727-8880
  • Fax: 540-727-8882
Mailing address:
  • Phone: 540-727-8880
  • Fax: 540-727-8882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.007232
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011008237
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: