Provider Demographics
NPI:1982172169
Name:MARYLAND KIDNEY CARE LLC
Entity type:Organization
Organization Name:MARYLAND KIDNEY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IKENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:EZUMBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-835-8683
Mailing Address - Street 1:826 WASHINGTON RD STE 205
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5780
Mailing Address - Country:US
Mailing Address - Phone:410-386-9099
Mailing Address - Fax:
Practice Address - Street 1:826 WASHINGTON RD STE 205
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5780
Practice Address - Country:US
Practice Address - Phone:410-386-9099
Practice Address - Fax:410-386-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty