Koontz, Samantha D
Koontz, Samantha D is an individual health care provider with primary practice located at 56 Thomas Johnson Dr , Frederick MD 21702-4599. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Koontz, Samantha D can be contacted via phone (301) 694-3111.Contact Information
Primary practice address
56 Thomas Johnson Dr
Frederick MD 21702-4599
Phone: (301) 694-3111
Fax: (301) 694-8626
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | C0005971 | Maryland |
Profile Details
| NPI number | 1740653294 |
|---|---|
| LBN Legal business name | Koontz, Samantha D |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 5th, 2015 |
| Last updated | Sep 15th, 2016 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1740653294 | NPPES |
| Maryland | MEDICAID | 926580505 | |
| Maryland | MEDICAID | 926580503 |
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