Healthcare Provider Details

I. General information

NPI: 1073729208
Provider Name (Legal Business Name): KENNEDY KRIEGER CHILDREN'S HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N BROADWAY
BALTIMORE MD
21205-1832
US

IV. Provider business mailing address

P.O.BOX 744865
ATLANTA GA
30374
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-9200
  • Fax: 443-923-9405
Mailing address:
  • Phone: 443-923-1886
  • Fax: 443-923-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number30-036
License Number StateMD

VIII. Authorized Official

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