Healthcare Provider Details

I. General information

NPI: 1346308095
Provider Name (Legal Business Name): KENNETH C SCHOENDORF MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 11/27/2023
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 LANIER AVE
BALTIMORE MD
21215-5321
US

IV. Provider business mailing address

5101 LANIER AVE
BALTIMORE MD
21215-5321
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-9300
  • Fax: 410-601-9499
Mailing address:
  • Phone: 410-601-9300
  • Fax: 410-601-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0043597
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: