Provider Demographics
NPI:1720225766
Name:KANE, ADRIENNE DOROTHY (PA)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:DOROTHY
Last Name:KANE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10724 LITTLE PATUXENT PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3249
Mailing Address - Country:US
Mailing Address - Phone:410-997-1336
Mailing Address - Fax:410-997-1636
Practice Address - Street 1:2500 MERCED ST BLDG A4TH
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4201
Practice Address - Country:US
Practice Address - Phone:510-454-7300
Practice Address - Fax:510-454-7269
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA52981363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant