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NPI Code Detail

MEDICARE: KIMBERLY KUCZYNSKI MS, RD, LD

MEDICARE: KIMBERLY KUCZYNSKI MS, RD, LD
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
1133V00000XRegistered DietitianD02227MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D02227OTHERMDCOMMERICAL INSURANCE

General Provider Information

NPI Number : 1962928747
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY KUCZYNSKI MS, RD, LD
Provider Business Mailing Address
First Line : 7106 LADYSLIPPER LN
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20772-6328
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13400 EDGEMEADE RD
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20772-8088
Country : US
Telephone Number : 215-964-1657
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2017
Last Update Date : 03/17/2018

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