Provider Demographics
NPI:1639481476
Name:KVASNOVSKY, CHARLOTTE LOUISE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:LOUISE
Last Name:KVASNOVSKY
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 SAINT PAUL ST
Mailing Address - Street 2:FLOOR 4
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2405
Mailing Address - Country:US
Mailing Address - Phone:240-383-2157
Mailing Address - Fax:
Practice Address - Street 1:827 SAINT PAUL ST
Practice Address - Street 2:FLOOR 4
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2405
Practice Address - Country:US
Practice Address - Phone:240-383-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1623032086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery