MEDICARE: DR. KRISTEN SKONIECZNY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1164009163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN SKONIECZNY DO

Provider Business Mailing Address
First Line	:	4755 OGLETOWN STANTON RD
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19718-2200
Country	:	US
Telephone Number	:	302-733-4503
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 CENTER DRIVE MSC 1201
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20892-2200
Country	:	US
Telephone Number	:	240-858-3080
Fax Number	:	301-402-1738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2021
Last Update Date	:	06/30/2024

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