1689037400 NPI number — STEPHANIE JO KEMP

Table of content: STEPHANIE JO KEMP (NPI 1689037400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689037400 NPI number — STEPHANIE JO KEMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEMP
Provider First Name:
STEPHANIE
Provider Middle Name:
JO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KARGER
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689037400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9910 FRANKLIN SQUARE DR # 2110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21236-4902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-933-6421
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1830 E MONUMENT ST
Provider Second Line Business Practice Location Address:
SUITE 6-100
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21287-0020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-955-3380
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2016

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: 207P00000X , with the licence number:  D86937 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: D86937 . This is a "LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".