Provider Demographics
NPI:1649491721
Name:KUNZ, RONALD THOMAS (IDC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:THOMAS
Last Name:KUNZ
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 GRIER RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5002
Mailing Address - Country:US
Mailing Address - Phone:301-619-3051
Mailing Address - Fax:
Practice Address - Street 1:1681 NELSON ST
Practice Address - Street 2:
Practice Address - City:FORT DETRICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9203
Practice Address - Country:US
Practice Address - Phone:301-619-3051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman