1841337805 NPI number — JAMES LAWRENCE KERNAN HOSPITAL, INC.

Table of Contents

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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