Provider Demographics
NPI:1881748325
Name:RICHARD A KURNOT MD PA
Entity type:Organization
Organization Name:RICHARD A KURNOT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KURNOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-774-2525
Mailing Address - Street 1:18109 PRINCE PHILIP DR
Mailing Address - Street 2:SUITE #270
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1593
Mailing Address - Country:US
Mailing Address - Phone:301-774-2525
Mailing Address - Fax:301-774-4245
Practice Address - Street 1:18109 PRINCE PHILIP DR
Practice Address - Street 2:SUITE #270
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1593
Practice Address - Country:US
Practice Address - Phone:301-774-2525
Practice Address - Fax:301-774-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD045868208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD323651000Medicaid
MDMD045868OtherSTATE LICENCE
MD323651000Medicaid
E45821Medicare UPIN