MEDICARE: CKNMG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1902763162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CKNMG

Provider Business Mailing Address
First Line	:	1501 S CLINTON ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-5730
Country	:	US
Telephone Number	:	866-233-6925
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 S CLINTON ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-5730
Country	:	US
Telephone Number	:	866-233-6925
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARY JANE FAVAZZA
Credential	:
Telephone Number	:	410-205-1487

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/20/2026

Similar Medicare Providers

1407960032 — STEVEN ALLEN BLACKWELL PH.D., J.D., R.PH.
Practice Location Address:

7500 SECURITY BLVD # C3-20-17 , CENTERS FOR MEDICARE & MEDICAID SERVICES
BALTIMORE, MD
21244-1849

Practice Phone: 410-786-6852
Practice Fax:

1396961561 — DR. MARSHA SMITH MD
Practice Location Address:

7500 SECURITY BOULEVARD , CENTERS FOR MEDICARE & MEDICAID SERVICES
BALTIMORE, MD
21201-2301

Practice Phone: 410-786-6614
Practice Fax:

1134335441 — JULIE DAWN PREIS
Practice Location Address:

7500 SECURITY BLVD MS C1-13-07 , CENTERS FOR MEDICARE & MEDICAID SERVICES
BALTIMORE, MD
21244

Practice Phone: 410-786-0525
Practice Fax:

1871453969 — CKNMG
Practice Location Address:

1501 S CLINTON ST
BALTIMORE, MD
21224-5730

Practice Phone: 866-233-6925
Practice Fax:

1891655999 — CKNMG
Practice Location Address:

1501 S CLINTON ST
BALTIMORE, MD
21224-5730

Practice Phone: 866-233-6925
Practice Fax:

1902766009 — CKNMG
Practice Location Address:

1501 S CLINTON ST
BALTIMORE, MD
21224-5730

Practice Phone: 866-233-6925
Practice Fax:

Directions to “CKNMG ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.