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General NPI Number Information
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NPI Number | 1285654855
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Entity Type | Individual
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Provider Name | KATHLEEN LOUZON DEMARIO CRNP
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Gender | Female
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 3900 LOCH RAVEN BLVD
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City | BALTIMORE
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State | MD
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Zip | 21218-2108
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Country | US
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Telephone | 410-605-7620
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Fax | 410-209-8418
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Provider Business Mailing Address
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Address Line | 2801 DEMARIO DR
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City | MANCHESTER
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State | MD
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Zip | 21102-1987
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Country | US
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Telephone | 410-358-2397
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Fax | 410-358-2399
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | R089949
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License Number State | MD
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