Provider Demographics
NPI:1164598330
Name:KERZNER, BORIS (MD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:KERZNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 QUARRY LAKE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3744
Mailing Address - Country:US
Mailing Address - Phone:410-415-5811
Mailing Address - Fax:
Practice Address - Street 1:2700 QUARRY LAKE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3744
Practice Address - Country:US
Practice Address - Phone:410-415-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019317207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD35880170Medicaid
MDKS30OtherCAREFIRST
MDT-754OtherFEDERAL BLUE CROSS
MD35880170Medicaid
MD35880170Medicaid
MD35880170Medicaid