Basic Information
| Provider Information | |||||||||
| NPI: | 1649595141 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KENNEDY KRIEGER INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2931 E BIDDLE ST | ||||||||
| Address2: | PATIENT ACCOUNTING HELENA PORTER | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212133939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439231886 | ||||||||
| FaxNumber: | 4439231895 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 N BROADWAY | ||||||||
| Address2: | KENNEDY KRIEGER INSTITUTE | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212051832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439239400 | ||||||||
| FaxNumber: | 4439239405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2010 | ||||||||
| LastUpdateDate: | 10/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | NEUMAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4439231810 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KENNEDY KRIGER CHILDREN'S HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 802 | MD | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.