Provider Demographics
NPI:1114912730
Name:KREJCI, KATHLEEN SARAH (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:SARAH
Last Name:KREJCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:SARAH
Other - Last Name:NEAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:965 RUSTLING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1800
Mailing Address - Country:US
Mailing Address - Phone:410-987-4176
Mailing Address - Fax:
Practice Address - Street 1:3100 MOUNTAIN RD
Practice Address - Street 2:PEDIATRIC PLACE
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2018
Practice Address - Country:US
Practice Address - Phone:410-360-4446
Practice Address - Fax:410-360-4449
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43310208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN210884Medicare UPIN