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Individual

SAMANTHA D KOONTZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
56 THOMAS JOHNSON DR, FREDERICK, MD 21702-4599
(301) 694-3111
(301) 694-8626
Mailing address
610 SOLAREX CT, FREDERICK, MD 21703-8624

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0005971
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
926580503
MD
05
926580505
MD
Enumeration date
11/05/2015
Last updated
09/15/2016
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