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NPI Code Detail

MEDICARE: DR. KENETRA HIX M.D.

MEDICARE: DR. KENETRA HIX M.D.
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
1207Q00000XFamily Medicine PhysicianMD046514DC
2207Q00000XFamily Medicine PhysicianD0092222MD

General Provider Information

NPI Number : 1972917979
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENETRA HIX M.D.
Provider Business Mailing Address
First Line : 1111 N CHARLES ST
Second Line :
City : BALTIMORE
State : MD
Zip : 21201-5505
Country : US
Telephone Number : 410-837-2050
Fax Number : 866-629-0091
Provider Business Practice Location Address
First Line : 3510 BRENBROOK DR
Second Line :
City : RANDALLSTOWN
State : MD
Zip : 21133-4902
Country : US
Telephone Number : 410-837-2050
Fax Number : 866-629-0091
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2014
Last Update Date : 07/31/2023

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