Provider Demographics
NPI:1689833204
Name:KUNTZ, COLLETTE ROSE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:COLLETTE
Middle Name:ROSE
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 S WALTER REED DR APT A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-4090
Mailing Address - Country:US
Mailing Address - Phone:808-256-1302
Mailing Address - Fax:
Practice Address - Street 1:9135 PISCATAWAY RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2549
Practice Address - Country:US
Practice Address - Phone:301-265-0093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003767363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical