Provider Demographics
NPI:1932226032
Name:KAPUNAN, PATRICIA ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELLEN
Last Name:KAPUNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SCHOFIELD ROAD, BLDG 1178
Mailing Address - Street 2:FORT SAM HOUSTON ADOLESCENT MEDICINE CLINIC
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6400
Mailing Address - Country:US
Mailing Address - Phone:210-808-2370
Mailing Address - Fax:
Practice Address - Street 1:6900 GEORGIA AVE NW
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS WALTER REED AMC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242574208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics