Provider Demographics
NPI:1659371888
Name:HUZELLA, KINGA MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:KINGA
Middle Name:MICHELLE
Last Name:HUZELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:220 CHAMPION DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6558
Mailing Address - Country:US
Mailing Address - Phone:301-791-0888
Mailing Address - Fax:301-791-3611
Practice Address - Street 1:220 CHAMPION DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6558
Practice Address - Country:US
Practice Address - Phone:301-791-0888
Practice Address - Fax:301-791-3611
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2014-04-28
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Provider Licenses
StateLicense IDTaxonomies
MDD0053753207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD480502000Medicaid
MD324548YMD2Medicare PIN
MD480502000Medicaid