Provider Demographics
NPI:1508407560
Name:COVENANT NEPHROLOGY LLC
Entity Type:Organization
Organization Name:COVENANT NEPHROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSITER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-627-9548
Mailing Address - Street 1:13003 HEIL MANOR DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-5712
Mailing Address - Country:US
Mailing Address - Phone:410-627-9548
Mailing Address - Fax:
Practice Address - Street 1:13003 HEIL MANOR DR
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-5712
Practice Address - Country:US
Practice Address - Phone:410-627-9548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty