Healthcare Provider Details

I. General information

NPI: 1295760486
Provider Name (Legal Business Name): KYLE ANN SLOAN P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLE ANN RUTKOWSKI P.A.-C.

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

6038 RIVER BIRCH COURT
HANOVER MD
21076
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0350
  • Fax:
Mailing address:
  • Phone: 443-610-3794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC02954
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: