Provider Demographics
NPI:1205168770
Name:KOCZMAN, MICHELE EMORY (PA)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:EMORY
Last Name:KOCZMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:EMORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:451 JAMES MADISON HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-2361
Mailing Address - Country:US
Mailing Address - Phone:540-727-8880
Mailing Address - Fax:540-727-8882
Practice Address - Street 1:451 JAMES MADISON HWY STE 104
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-2361
Practice Address - Country:US
Practice Address - Phone:540-727-8880
Practice Address - Fax:540-727-8882
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.007232363A00000X
VA011008237363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant