1114784691 NPI number — JAMIE CAROL KEMPER RDH

Table of content: JAMIE CAROL KEMPER RDH (NPI 1114784691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114784691 NPI number — JAMIE CAROL KEMPER RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEMPER
Provider First Name:
JAMIE
Provider Middle Name:
CAROL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEMPER
Provider Other First Name:
JAMIE
Provider Other Middle Name:
CAROL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1114784691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
249 WENDOVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21122-3138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-717-9556
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
THE UNITED STATES COAST GUARD YARD
Provider Second Line Business Practice Location Address:
2401 HAWKINS POINT RD
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21226-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-717-9556
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2024

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: 124Q00000X , with the licence number:  8825 , 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)