Provider Demographics
NPI:1225165848
Name:KURKOSKI, CHRISTINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:KURKOSKI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 BROADMOOR TER N
Mailing Address - Street 2:
Mailing Address - City:IJAMSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21754-9149
Mailing Address - Country:US
Mailing Address - Phone:301-788-6047
Mailing Address - Fax:301-663-0642
Practice Address - Street 1:1519 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-3724
Practice Address - Country:US
Practice Address - Phone:301-663-3338
Practice Address - Fax:301-663-0642
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD01035213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6546280001Medicare NSC
MD263LMedicare PIN