Healthcare Provider Details

I. General information

NPI: 1871515783
Provider Name (Legal Business Name): KENNEDY KRIEGER ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N BROADWAY
BALTIMORE MD
21205-1832
US

IV. Provider business mailing address

PO BOX 744865
ATLANTA GA
30374-4865
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-1070
  • Fax: 443-923-1875
Mailing address:
  • Phone: 443-923-1886
  • Fax: 443-923-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL J NEUMAN
Title or Position: VICE PRESIDENT FINANCE
Credential:
Phone: 443-923-1810