Provider Demographics
NPI:1679520779
Name:RANNEY, KATHLEEN ANNE (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:RANNEY
Suffix:
Gender:F
Credentials:MD
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 64374
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4273
Mailing Address - Country:US
Mailing Address - Phone:410-328-6720
Mailing Address - Fax:410-328-1674
Practice Address - Street 1:110 S PACA ST
Practice Address - Street 2:6TH FLOOR, SUITE 300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1642
Practice Address - Country:US
Practice Address - Phone:410-328-6331
Practice Address - Fax:410-328-1674
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055755207L00000X
VA0101056090207L00000X
MDD55755207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
601285800OtherFECA
MD125218600Medicaid
MDP00745077OtherRR MEDICARE (GRP PTAN DD6120)
DCS417-0017OtherCAREFIRST BCBS
MDKBC1CHOtherCAREFIRST BCBS
601285800OtherFECA
MD839MK234Medicare ID - Type UnspecifiedGROUP 839M
MD144718Y2MMedicare PIN
H17924Medicare UPIN