Healthcare Provider Details

I. General information

NPI: 1770760449
Provider Name (Legal Business Name): MARYLAND KIDNEY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9103 FRANKLIN SQUARE DR SUITE 301
BALTIMORE MD
21237-3900
US

IV. Provider business mailing address

9103 FRANKLIN SQUARE DR SUITE 301
BALTIMORE MD
21237-3900
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-6540
  • Fax: 443-777-6543
Mailing address:
  • Phone: 443-777-6540
  • Fax: 443-777-6543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KHALID K AL-TALIB
Title or Position: MEMBER
Credential: M.D.
Phone: 443-777-6540