Provider Demographics
NPI:1750728317
Name:BLENNER, KATIE C (MD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:C
Last Name:BLENNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:C
Other - Last Name:BLENNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6701 N. CHARLES STREET
Mailing Address - Street 2:SOUTH CHAPMAN BLDG STE 102
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:443-849-2459
Mailing Address - Fax:443-849-3138
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6881
Practice Address - Country:US
Practice Address - Phone:443-829-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD83819207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology