Healthcare Provider Details

I. General information

NPI: 1780034942
Provider Name (Legal Business Name): INGRID KOHLSTADT MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 PRINCE GEORGE ST
ANNAPOLIS MD
21401-1724
US

IV. Provider business mailing address

198 PRINCE GEORGE ST
ANNAPOLIS MD
21401-1724
US

V. Phone/Fax

Practice location:
  • Phone: 410-858-4989
  • Fax:
Mailing address:
  • Phone: 410-858-4989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberD47779
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: