Provider Demographics
NPI:1518193630
Name:KINDRED, CHESAHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHESAHNA
Middle Name:
Last Name:KINDRED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHESAHNA
Other - Middle Name:
Other - Last Name:KINDRED WEAVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8900 COLUMBIA 100 PKWY STE F
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2336
Mailing Address - Country:US
Mailing Address - Phone:443-424-7754
Mailing Address - Fax:443-303-2913
Practice Address - Street 1:8900 COLUMBIA 100 PKWY STE F
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2336
Practice Address - Country:US
Practice Address - Phone:443-424-7754
Practice Address - Fax:443-303-2913
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD74743207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD74743OtherMEDICAL LICENSE