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NPI Code Detail

MEDICARE: KATHLEEN ANN PELTZ P.A.

MEDICARE: KATHLEEN ANN PELTZ P.A.
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
1363AM0700XMedical Physician Assistant
2363A00000XPhysician Assistant0110010059VA

General Provider Information

NPI Number : 1306102645
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN ANN PELTZ P.A.
Provider Business Mailing Address
First Line : 230 BROWNS WAY RD
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-9501
Country : US
Telephone Number : 440-344-8162
Fax Number :
Provider Business Practice Location Address
First Line : 230 BROWNS WAY RD
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-9501
Country : US
Telephone Number : 804-419-9101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2012
Last Update Date : 12/10/2025

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