Provider Demographics
NPI:1881147403
Name:REISINGER, KRISTIN PETRONIO (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:PETRONIO
Last Name:REISINGER
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 1:501 N FREDERICK AVE
Mailing Address - Street 2:#302
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877
Mailing Address - Country:US
Mailing Address - Phone:301-591-8261
Mailing Address - Fax:
Practice Address - Street 1:501 N FREDERICK AVE
Practice Address - Street 2:SUITE #302
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2507
Practice Address - Country:US
Practice Address - Phone:301-591-8261
Practice Address - Fax:301-591-8262
Is Sole Proprietor?:No
Enumeration Date:2016-07-31
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058307363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant