Healthcare Provider Details

I. General information

NPI: 1639481476
Provider Name (Legal Business Name): CHARLOTTE LOUISE KVASNOVSKY MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 SAINT PAUL ST FLOOR 4
BALTIMORE MD
21202-2405
US

IV. Provider business mailing address

827 SAINT PAUL ST FLOOR 4
BALTIMORE MD
21202-2405
US

V. Phone/Fax

Practice location:
  • Phone: 240-383-2157
  • Fax:
Mailing address:
  • Phone: 240-383-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number036-162303
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: