Provider Demographics
NPI:1487742664
Name:KINZEL, JULIE (PA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:KINZEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLMAR
Mailing Address - State:PA
Mailing Address - Zip Code:18915-9786
Mailing Address - Country:US
Mailing Address - Phone:215-977-9377
Mailing Address - Fax:215-997-8891
Practice Address - Street 1:2303 N BROAD ST
Practice Address - Street 2:
Practice Address - City:COLMAR
Practice Address - State:PA
Practice Address - Zip Code:18915-9786
Practice Address - Country:US
Practice Address - Phone:215-977-9377
Practice Address - Fax:215-997-8891
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003498L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P47412Medicare PIN
PA69665Medicare ID - Type Unspecified