Basic Information
| Provider Information | |||||||||
| NPI: | 1679520779 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANNEY | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64374 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103286720 | ||||||||
| FaxNumber: | 4103281674 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 S PACA ST | ||||||||
| Address2: | 6TH FLOOR, SUITE 300 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103286331 | ||||||||
| FaxNumber: | 4103281674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | D0055755 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 0101056090 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | D55755 | MD | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 601285800 | 01 | FECA | OTHER | 125218600 | 05 | MD | MEDICAID | P00745077 | 01 | MD | RR MEDICARE (GRP PTAN DD6120) | OTHER | S417-0017 | 01 | DC | CAREFIRST BCBS | OTHER | KBC1CH | 01 | MD | CAREFIRST BCBS | OTHER |