Healthcare Provider Details

I. General information

NPI: 1295826592
Provider Name (Legal Business Name): ROBERT L KANE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N GREENE ST VA MEDICAL CENER (127)
BALTIMORE MD
21201-1524
US

IV. Provider business mailing address

5337 HIGH WHEELS CT
COLUMBIA MD
21044-5716
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7414
  • Fax: 410-605-7705
Mailing address:
  • Phone: 410-605-7414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3059
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: