Provider Demographics
NPI:1508902784
Name:REDMOND, KRISTIN JANSON (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JANSON
Last Name:REDMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:JANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64474
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4474
Mailing Address - Country:US
Mailing Address - Phone:410-502-8000
Mailing Address - Fax:
Practice Address - Street 1:401 N BROADWAY
Practice Address - Street 2:SUITE 1440
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-1146
Practice Address - Country:US
Practice Address - Phone:410-955-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2017942085R0001X
MDD711752085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD037469500Medicaid
MD037469500Medicaid
MD188881YFUVMedicare PIN