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General NPI Number Information
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NPI Number | 1225300072
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Entity Type | Organization
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Legal Business Name | KEVIN L LASER MD
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 512 BENFOREST DR
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City | SEVERNA PARK
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State | MD
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Zip | 21146-1735
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Country | US
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Telephone | 410-615-3707
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Fax |
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Provider Business Mailing Address
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Address Line | 512 BENFOREST DR
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City | SEVERNA PARK
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State | MD
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Zip | 21146-1735
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Country | US
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Telephone | 410-615-3707
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | KEVIN LAWRENCE LASER
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Credential | M.D.
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Telephone | 410-615-3707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D35560
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License Number State | MD
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