Provider Demographics
NPI:1770760449
Name:MARYLAND KIDNEY ASSOCIATES, LLC
Entity type:Organization
Organization Name:MARYLAND KIDNEY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:K
Authorized Official - Last Name:AL-TALIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-777-6540
Mailing Address - Street 1:9103 FRANKLIN SQUARE DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3900
Mailing Address - Country:US
Mailing Address - Phone:443-777-6540
Mailing Address - Fax:443-777-6543
Practice Address - Street 1:9103 FRANKLIN SQUARE DR
Practice Address - Street 2:SUITE 301
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3900
Practice Address - Country:US
Practice Address - Phone:443-777-6540
Practice Address - Fax:443-777-6543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty