Provider Demographics
NPI:1295843217
Name:KIDNEY MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:KIDNEY MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:APRIL
Authorized Official - Last Name:UNGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-638-7802
Mailing Address - Street 1:4475 REGENCY PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3072
Mailing Address - Country:US
Mailing Address - Phone:301-638-7802
Mailing Address - Fax:301-638-7805
Practice Address - Street 1:4475 REGENCY PL
Practice Address - Street 2:SUITE 201
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3072
Practice Address - Country:US
Practice Address - Phone:301-638-7802
Practice Address - Fax:301-638-7805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0452OtherBLUE CHOICE
DF9122OtherMEDICARE RAILROAD
VA010336864Medicaid
MD411242301Medicaid
VA010336864Medicaid
MD0452OtherBLUE CHOICE
DF9122OtherMEDICARE RAILROAD
MD346PMedicare PIN