Individual provider Active NPI

Cody Brennan Keeth

  • Acute Care Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1104446210
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
R254126 Issued in MD
Practice address
22 S Greene St
Baltimore, MD 21201-1544
Phone
(667) 214-1734
Fax
(410) 706-6976
NPI assigned
Apr 17, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X R254126 MD Primary

Addresses

Primary practice location

22 S Greene St
Baltimore, MD 21201-1544

Mailing address

PO Box 64226
Baltimore, MD 21264-4226
Phone (667) 214-1734

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230117002785 MD Practitioner - Nurse Practitioner 5395116040 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R254126MDMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Maryland Community Medical Group, Inc. CurrentSince Nov 1, 2022 Accepting new patients
University of Maryland Community Medical Group, Inc. CurrentSince Nov 1, 2022 Accepting new patients
University of Maryland Surgical Associates, PA CurrentSince Mar 1, 2025 Accepting new patients
University of Maryland Surgcial Assoc PA Past Accepting new patients

Locations

419 W Redwood St
Ste 300
Baltimore, MD 21201
Phone (410) 328-5300

22 S Greene St
Baltimore, MD 21201
Phone (410) 328-5793

419 W Redwood St
Fl 3
Baltimore, MD 21201
Phone (410) 328-5300

2540 Centreville Rd
Centreville, MD 21617
Phone (410) 758-4432

219 S Washington St
Easton, MD 21601

301 Hospital Dr
Glen Burnie, MD 21061
Phone (410) 787-4565

900 Elkridge Landing Rd
Fl 2
Linthicum Heights, MD 21090
Phone (443) 462-5010

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1104446210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64226",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212644226",
            "telephone_number": "667-214-1734",
            "fax_number": "410-706-6976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544",
            "telephone_number": "667-214-1734",
            "fax_number": "410-706-6976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEETH",
        "first_name": "CODY",
        "middle_name": "BRENNAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-17",
        "last_updated": "2025-09-11",
        "certification_date": "2025-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MD",
            "license": "R254126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.