=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982344321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA KUSCSIK NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2022
-----------------------------------------------------
Last Update Date | 04/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9109 STONY POINT DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-1979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-288-5222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2420 OLDE STONE RD
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23113-9614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-304-2179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | 0024183251
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------