Individual provider · Type 1 NPI

Kelly Distasio

Physician Assistant · Clinton, MD

NPI number 1801639554 Active

Practice location

7503 Surratts Rd
Clinton, MD 20735-3358

Call (301) 877-7202 Map

Mailing address

7501 Surratts Rd, Pob Suite 303
Clinton, MD 20735-3362

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant Primary 363A00000X0110011392 (VA)

Physician Assistant: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…

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About NPI 1801639554

Kelly Distasio's National Provider Identifier is 1801639554, issued on Jun 18, 2024. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in Clinton, MD. The record was last updated on Aug 14, 2026.