Provider Demographics
NPI:1053446856
Name:KIDORF, MICHAEL S (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:KIDORF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 WILLOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3136
Mailing Address - Country:US
Mailing Address - Phone:410-602-6062
Mailing Address - Fax:
Practice Address - Street 1:5510 NATHAN SHOCK DR
Practice Address - Street 2:SUITE 1500
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6823
Practice Address - Country:US
Practice Address - Phone:410-550-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical