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General NPI Number Information
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NPI Number | 1689833204
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Entity Type | Individual
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Provider Name | COLLETTE ROSE KUNTZ P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 9135 PISCATAWAY RD
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City | CLINTON
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State | MD
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Zip | 20735-2549
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Country | US
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Telephone | 301-265-0093
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Fax |
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Provider Business Mailing Address
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Address Line | 2442 S WALTER REED DR APT A
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City | ARLINGTON
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State | VA
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Zip | 22206-4090
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Country | US
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Telephone | 808-256-1302
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0003767
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License Number State | MD
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