1114912730 NPI number — DR. KATHLEEN SARAH KREJCI MD

Table of content: DR. KATHLEEN SARAH KREJCI MD (NPI 1114912730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114912730 NPI number — DR. KATHLEEN SARAH KREJCI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KREJCI
Provider First Name:
KATHLEEN
Provider Middle Name:
SARAH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEAVES
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
SARAH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114912730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
965 RUSTLING OAKS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLERSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21108-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-987-4176
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 MOUNTAIN RD
Provider Second Line Business Practice Location Address:
PEDIATRIC PLACE
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21122-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-360-4446
Provider Business Practice Location Address Fax Number:
410-360-4449
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  43310 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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