Healthcare Provider Details

I. General information

NPI: 1457976243
Provider Name (Legal Business Name): LAUREN KNIGHTLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEDICAL PKWY
ANNAPOLIS MD
21401-3742
US

IV. Provider business mailing address

2000 MEDICAL PKWY STE 306
ANNAPOLIS MD
21401-3745
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-9700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0100472
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: