Organization
ST. AGNES HEALTHCARE, INC.
Active
Parent organization
ST. AGNES HEALTHCARE, INC.
Other names
St. Agnes Professional Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. AGNES HEALTHCARE, INC.
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) 234-2947
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
—
—
2085B0100X
Body Imaging Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Enumeration date
06/24/2010
Last updated
02/25/2016
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