Provider Demographics
NPI:1023868270
Name:MCCANS, KERRY
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:MCCANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S GREENE ST # N5W70A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1591
Mailing Address - Country:US
Mailing Address - Phone:103-286-9604
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST # N5W70A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1591
Practice Address - Country:US
Practice Address - Phone:410-328-6960
Practice Address - Fax:410-328-0646
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program