Provider Demographics
NPI:1841337805
Name:JAMES LAWRENCE KERNAN HOSPITAL, INC.
Entity type:Organization
Organization Name:JAMES LAWRENCE KERNAN HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-448-6289
Mailing Address - Street 1:11311 MCCORMICK RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1004
Mailing Address - Country:US
Mailing Address - Phone:410-821-4140
Mailing Address - Fax:410-821-4189
Practice Address - Street 1:2200 KERNAN DR
Practice Address - Street 2:EXECUTIVE OFFICE, SUITE 1183
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-6665
Practice Address - Country:US
Practice Address - Phone:410-448-6701
Practice Address - Fax:410-448-2859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30038282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMD1OtherBLUE CHOICE BLUE PREFERRE
MD57348701OtherBC OF MARYLAND
MDMD1OtherBC FEDERAL PROGRAM
MDMD1OtherBCBS CAPITAL CARE
MD093575100Medicaid
MD=========OtherFIDELITY BENEFIT ADMINIST
MD=========OtherMAILHANDLERS
MDMD1OtherBC FEDERAL PROGRAM
MD=========OtherCAREFIRST ADMINISTRATORS
MD=========OtherCORESOURCE
MD=========OtherBC OUT OF STATE
MD=========OtherCONSTRUCTION WORKERS
MD=========OtherEHP
MDMD1OtherBCBS CAPITAL CARE
MDMD1OtherBLUE CHOICE BLUE PREFERRE
MD=========OtherAETNA
MD=========OtherGEHA
MD=========OtherBC NASCO
MD=========OtherALLIANCE PPO
MD=========OtherMAILHANDLERS