Provider Demographics
NPI:1134128903
Name:OWENS, KERRY ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ELIZABETH
Last Name:OWENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 FREDERICK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4712
Mailing Address - Country:US
Mailing Address - Phone:410-744-0900
Mailing Address - Fax:410-477-3160
Practice Address - Street 1:300 FREDERICK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4665
Practice Address - Country:US
Practice Address - Phone:410-744-0900
Practice Address - Fax:410-744-3160
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057344208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH44018Medicare UPIN
MD059M88Medicare ID - Type Unspecified
MDK519/138720YSMMedicare PIN