Provider Demographics
NPI:1871673517
Name:KENT QUEEN ANNE PATHOLOGY
Entity Type:Organization
Organization Name:KENT QUEEN ANNE PATHOLOGY
Other - Org Name:CHESTER RIVER HOSPITAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR PATIENT FINANCIAL SVCS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELL
Authorized Official - Middle Name:T
Authorized Official - Last Name:FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPAM
Authorized Official - Phone:410-778-7668
Mailing Address - Street 1:100 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1435
Mailing Address - Country:US
Mailing Address - Phone:410-778-3300
Mailing Address - Fax:410-778-7650
Practice Address - Street 1:100 BROWN ST
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1435
Practice Address - Country:US
Practice Address - Phone:410-778-3300
Practice Address - Fax:410-778-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14-002282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD210030Medicare Oscar/Certification
MDGS03Medicare PIN
MDGS04Medicare PIN