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Organization
ST. AGNES HEALTHCARE, INC.
Active
Organization
ST. AGNES HEALTHCARE, INC.
Active
Other names
ST.AGNES HOSPITAL
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH VANDER KOLK (PRESIDENT/CEO)
(667) 234-2101
Entity
Organization
Contact information
Practice address
900 CATON AVE, BALTIMORE, MD 21229-5201
(667) 234-2126
(667) 238-2947
Mailing address
3585 WASHINGTON BLVD, HALETHORPE, MD 21227-1676
(667) 234-2126
(667) 234-2947
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
282N00000X
General Acute Care Hospital
Primary
282N00000X
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000115500
—
MD
Enumeration date
06/15/2006
Last updated
02/25/2016
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