Provider Demographics
NPI:1952329336
Name:TRENT-MIMS, KAREN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TRENT-MIMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 DEER PARK RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-5912
Mailing Address - Country:US
Mailing Address - Phone:410-833-4741
Mailing Address - Fax:
Practice Address - Street 1:4 W ROLLING CROSSROADS
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-6280
Practice Address - Country:US
Practice Address - Phone:410-869-0100
Practice Address - Fax:410-869-0460
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD93484Medicaid
281961OtherMAMSI
4515143002OtherCIGNA
2331062OtherAETNA HMO
039557OtherJOHNS HOPKINS HEALTHCARE
52053501OtherCAREFIRST MARYLAND
7065116OtherAETNA PPO
0032OtherCAREFIRST DC
0713092OtherUNITED HEALTHCARE
E49945Medicare UPIN
X966Medicare ID - Type Unspecified