Healthcare Provider Details

I. General information

NPI: 1285654855
Provider Name (Legal Business Name): KATHLEEN LOUZON DEMARIO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LOCH RAVEN BLVD
BALTIMORE MD
21218-2108
US

IV. Provider business mailing address

2801 DEMARIO DR
MANCHESTER MD
21102-1987
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7620
  • Fax: 410-209-8418
Mailing address:
  • Phone: 410-358-2397
  • Fax: 410-358-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR089949
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: