Healthcare Provider Details

I. General information

NPI: 1578983540
Provider Name (Legal Business Name): MATTHEW BRYANT KUEHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PARKWAY
ANNAPOLIS MD
21401-3280
US

IV. Provider business mailing address

P.O. BOX 62239
BALTIMORE MD
21264-2239
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1366
  • Fax: 443-481-1370
Mailing address:
  • Phone: 410-931-0400
  • Fax: 410-931-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD82934
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: