Healthcare Provider Details

I. General information

NPI: 1871673517
Provider Name (Legal Business Name): KENT QUEEN ANNE PATHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BROWN ST
CHESTERTOWN MD
21620-1435
US

IV. Provider business mailing address

100 BROWN ST
CHESTERTOWN MD
21620-1435
US

V. Phone/Fax

Practice location:
  • Phone: 410-778-3300
  • Fax: 410-778-7650
Mailing address:
  • Phone: 410-778-3300
  • Fax: 410-778-7650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number14-002
License Number StateMD

VIII. Authorized Official

Name: KENNETH KOZEL
Title or Position: CEO
Credential:
Phone: 410-822-1000