MEDICARE: MS. KRISTIN ANN BROWN LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	020202143	MD

General Provider Information

NPI Number	:	1346233749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIN ANN BROWN LAT

Provider Business Mailing Address
First Line	:	5407 ROLAND AVE STE 1
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21210-1990
Country	:	US
Telephone Number	:	410-323-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5407 ROLAND AVE STE 1
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21210-1990
Country	:	US
Telephone Number	:	410-323-7361
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/18/2023

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