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General NPI Number Information
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NPI Number | 1962200832
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Entity Type | Organization
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Legal Business Name | KENNEDY KRIEGER ASSOCIATES
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 801 N BROADWAY
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City | BALTIMORE
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State | MD
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Zip | 21205-1424
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Country | US
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Telephone | 443-923-2600
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Fax | 443-923-2605
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Provider Business Mailing Address
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Address Line | PO BOX 45944
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City | BALTIMORE
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State | MD
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Zip | 21297-5944
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Country | US
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Telephone | 443-923-1886
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT FINANCE
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Name | LISA BADIE
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Credential |
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Telephone | 443-923-1812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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