Healthcare Provider Details

I. General information

NPI: 1801847041
Provider Name (Legal Business Name): ALBERT KENNEDY KOERNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

1060 W PERIMETER RD STE 3K21
JB ANDREWS MD
20762-6602
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6704
  • Fax: 410-328-4124
Mailing address:
  • Phone: 240-314-9549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0056257
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: