Provider Demographics
NPI:1710262886
Name:KLUCINA, PEGGY J (PA)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:J
Last Name:KLUCINA
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:20010 CENTURY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1115
Mailing Address - Country:US
Mailing Address - Phone:240-686-2300
Mailing Address - Fax:240-686-2330
Practice Address - Street 1:41 MAGNA WAY STE 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-3073
Practice Address - Country:US
Practice Address - Phone:410-751-6684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2021-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0004615363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical