Provider Demographics
NPI:1407203581
Name:KINDERMENDER GLENBURNIE
Entity Type:Organization
Organization Name:KINDERMENDER GLENBURNIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEYVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-492-4000
Mailing Address - Street 1:7010 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2902
Mailing Address - Country:US
Mailing Address - Phone:443-492-4000
Mailing Address - Fax:443-492-4010
Practice Address - Street 1:7010 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2902
Practice Address - Country:US
Practice Address - Phone:443-492-4000
Practice Address - Fax:443-492-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care