Provider Demographics
NPI:1255337747
Name:KERN, DONNA MARIE (PAC)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:KERN
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Gender:F
Credentials:PAC
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Mailing Address - Street 1:510 UPPER CHESAPEAKE DR
Mailing Address - Street 2:S#518
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4328
Mailing Address - Country:US
Mailing Address - Phone:443-643-4530
Mailing Address - Fax:443-643-4535
Practice Address - Street 1:510 UPPER CHESAPEAKE DR
Practice Address - Street 2:S#518
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4328
Practice Address - Country:US
Practice Address - Phone:443-643-4530
Practice Address - Fax:443-643-4535
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2016-11-18
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Provider Licenses
StateLicense IDTaxonomies
MDC0000586363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P02717Medicare UPIN
MDS732-48EEMedicare ID - Type Unspecified