Basic Information
| Provider Information | |||||||||
| NPI: | 1881748325 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHARD A KURNOT MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18109 PRINCE PHILIP DR | ||||||||
| Address2: | SUITE #270 | ||||||||
| City: | OLNEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208321593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017742525 | ||||||||
| FaxNumber: | 3017744245 | ||||||||
| Practice Location | |||||||||
| Address1: | 18109 PRINCE PHILIP DR | ||||||||
| Address2: | SUITE #270 | ||||||||
| City: | OLNEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208321593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017742525 | ||||||||
| FaxNumber: | 3017744245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 10/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | KURNOT | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | ANDREW | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3017742525 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MD045868 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 323651000 | 05 | MD | MEDICAID | MD045868 | 01 | MD | STATE LICENCE | OTHER |