Healthcare Provider Details

I. General information

NPI: 1912921453
Provider Name (Legal Business Name): KAREN A. COUSINS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 LINDEN AVE
BALTIMORE MD
21201
US

IV. Provider business mailing address

PO BOX 64522
BALTIMORE MD
21264-4522
US

V. Phone/Fax

Practice location:
  • Phone: 410-225-8000
  • Fax:
Mailing address:
  • Phone: 410-225-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberH0064267
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: