Basic Information
| Provider Information | |||||||||
| NPI: | 1285228585 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KINETIC MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7110 AYERS MEADOW LN | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221504915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034855689 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9544 NEWBRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | POTOMAC | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208544480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034855689 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2021 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | NORWOOD | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7034855689 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNP | ||||||||
| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.