Provider Demographics
NPI:1467554568
Name:KVERNO, KARAN S (PMH NP)
Entity Type:Individual
Prefix:
First Name:KARAN
Middle Name:S
Last Name:KVERNO
Suffix:
Gender:F
Credentials:PMH NP
Other - Prefix:
Other - First Name:KARAN
Other - Middle Name:S
Other - Last Name:KVERNO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMH CNS
Mailing Address - Street 1:5601 LOCH RAVEN BLVD., RUSSELL MORGAN BLD SUITE 406
Mailing Address - Street 2:MEDSTAR GOOD SAMARITAN HOSPITAL, NEUROPSYCHIATRY INSTIT
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239
Mailing Address - Country:US
Mailing Address - Phone:443-444-4540
Mailing Address - Fax:855-778-6866
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:MEDSTAR GOOD SAMARITAN, RUSSELL MORGAN BLDG, SUITE 406
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2945
Practice Address - Country:US
Practice Address - Phone:443-444-4540
Practice Address - Fax:855-778-6866
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR092427363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS38475Medicare UPIN
MD722581Medicare PIN
S38475Medicare UPIN