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General NPI Number Information
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NPI Number | 1417364753
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Entity Type | Organization
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Legal Business Name | KINDER MENDER, LLC
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 07/18/2014
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Provider Practice Location Address
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Address Line | 6100 DOBBIN RD
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City | COLUMBIA
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State | MD
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Zip | 21045-5804
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Country | US
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Telephone | 443-492-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 6100 DOBBIN RD
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City | COLUMBIA
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State | MD
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Zip | 21045-5804
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Country | US
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Telephone | 443-492-4000
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | KEYVAN RAFEI
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Credential | M.D.
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Telephone | 443-492-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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