1841337805 NPI number — JAMES LAWRENCE KERNAN HOSPITAL, INC.

Table of content: (NPI 1841337805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841337805 NPI number — JAMES LAWRENCE KERNAN HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES LAWRENCE KERNAN HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841337805
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11311 MCCORMICK RD
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
HUNT VALLEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21031-1004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-821-4140
Provider Business Mailing Address Fax Number:
410-821-4189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 KERNAN DR
Provider Second Line Business Practice Location Address:
EXECUTIVE OFFICE, SUITE 1183
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21207-6665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-448-6701
Provider Business Practice Location Address Fax Number:
410-448-2859
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOGIN
Authorized Official First Name:
MARINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
410-448-6289

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 30038 , 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: MD1 . This is a "BLUE CHOICE BLUE PREFERRE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: MD1 . This is a "BC FEDERAL PROGRAM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: MD1 . This is a "BCBS CAPITAL CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 093575100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 57348701 . This is a "BC OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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