Provider Demographics
NPI:1912948878
Name:SLONE, KATHLEEN C (CNM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:C
Last Name:SLONE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64075
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4075
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3501 SAINT PAUL ST
Practice Address - Street 2:STE143
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2703
Practice Address - Country:US
Practice Address - Phone:410-235-0506
Practice Address - Fax:410-467-3159
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR051980367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLT35 / 421136-04OtherBC / BS OF MD
MDS186 / 0023OtherBLUECHOICE
MD468981000Medicaid
MD468981000Medicaid