Provider Demographics
NPI:1770564254
Name:KANE, MARCIA ANN (MD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:ANN
Last Name:KANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:ANN
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:820 CHARLES JAMES CIR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043
Mailing Address - Country:US
Mailing Address - Phone:410-465-4247
Mailing Address - Fax:
Practice Address - Street 1:111 PARK AVE
Practice Address - Street 2:HEALTH CARE FOR THE HOMELESS
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-837-5533
Practice Address - Fax:410-783-9241
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36224207R00000X
MDD26391207R00000X
DC32780207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD38172Medicaid
MD38172Medicaid
4889Medicare ID - Type Unspecified