Provider Demographics
NPI:1871827097
Name:OZDINEC, KATHY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ELIZABETH
Last Name:OZDINEC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KATHY
Other - Middle Name:ELIZABETH
Other - Last Name:KUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8118 GOOD LUCK RD
Mailing Address - Street 2:DCH /OR
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3574
Mailing Address - Country:US
Mailing Address - Phone:301-552-8500
Mailing Address - Fax:301-552-8135
Practice Address - Street 1:8118 GOOD LUCK RD
Practice Address - Street 2:DCH /OR
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3574
Practice Address - Country:US
Practice Address - Phone:301-552-8500
Practice Address - Fax:301-552-8135
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001423363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0001423OtherPA LICENSE