Healthcare Provider Details

I. General information

NPI: 1598909095
Provider Name (Legal Business Name): KATHLEEN HISE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 HOPKINS BAYVIEW CIRCLE ROOM 2A62
BALTIMORE MD
21264-1714
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-2301
  • Fax: 410-550-3256
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberD77191
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: