NPIMap

Organization Active NPI

Kohli LLC

Doing business as Revolution Medical Center

  • Specialist
  • Havre de Grace, MD
National Provider Identifier
1700165818
Registry record updated Aug 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
D 71586 Issued in MD
Legal business name
KOHLI LLC
Doing business as
Revolution Medical Center
Practice address
603 Revolution St
Havre de Grace, MD 21078-3319
Phone
(410) 942-1015
Fax
(410) 942-1016
NPI assigned
Aug 6, 2011
Last updated
Aug 6, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2011

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

Authorized official

Name
Ms. Crystal Marie Martin
Title
Office Manager
Phone
(410) 942-1015

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X D 50806 MD
Specialist 174400000X D 71586 MD Primary

Addresses

Primary practice location

603 Revolution St
Havre de Grace, MD 21078-3319

Mailing address

603 Revolution St
Havre de Grace, MD 21078-3319
Phone (410) 942-1015

Other names 1

  • Revolution Medical Center Doing business as

National Provider Directory

National Provider Directory

Locations

603 Revolution St
Hvre de Grace, MD 21078
Phone (410) 942-1015

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1312588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312588800000",
    "number": "1700165818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 REVOLUTION ST",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783319",
            "telephone_number": "410-942-1015",
            "fax_number": "410-942-1016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 REVOLUTION ST",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783319",
            "telephone_number": "410-942-1015",
            "fax_number": "410-942-1016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOHLI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-06",
        "last_updated": "2011-08-06",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "410-942-1015",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MD",
            "license": "D 50806",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MD",
            "license": "D 71586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revolution Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Havre de Grace, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.