Provider Demographics
NPI:1275870669
Name:KINDERMENDER LAUREL
Entity Type:Organization
Organization Name:KINDERMENDER LAUREL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEYVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-492-4000
Mailing Address - Street 1:10609 HARPOON HL
Mailing Address - Street 2:C/O KEYVAN RAFEI
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4157
Mailing Address - Country:US
Mailing Address - Phone:240-506-0739
Mailing Address - Fax:
Practice Address - Street 1:805 WASHINGTON BLVD S STE A
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4611
Practice Address - Country:US
Practice Address - Phone:443-492-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care