Provider Demographics
NPI:1659428118
Name:METRO RENAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:METRO RENAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-439-1332
Mailing Address - Street 1:821 N EUTAW ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-6304
Mailing Address - Country:US
Mailing Address - Phone:410-439-1332
Mailing Address - Fax:410-439-1335
Practice Address - Street 1:821 N EUTAW ST STE 407
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-6304
Practice Address - Country:US
Practice Address - Phone:410-439-1332
Practice Address - Fax:410-439-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD808001100Medicaid