MEDICARE: SAVANNAH ALEXANDRA KINLOCK

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	363A00000X	Physician Assistant	C0009869	MD

General Provider Information

NPI Number	:	1972246213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH ALEXANDRA KINLOCK

Provider Business Mailing Address
First Line	:	11804 REISTERSTOWN RD
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-3311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11804 REISTERSTOWN RD
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-3311
Country	:	US
Telephone Number	:	718-809-7494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	04/29/2025

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Directions to “ SAVANNAH ALEXANDRA KINLOCK ” Practice Location

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