Provider Demographics
NPI:1093715005
Name:AUSTIN, KENNETH IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:IAN
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5864 NEBRASKA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-1266
Mailing Address - Country:US
Mailing Address - Phone:202-832-4200
Mailing Address - Fax:202-529-1689
Practice Address - Street 1:1140 VARNUM ST NE
Practice Address - Street 2:SUITE # 201
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2151
Practice Address - Country:US
Practice Address - Phone:202-832-4200
Practice Address - Fax:202-529-1689
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD 2962207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C 88210Medicare UPIN
DC172925Medicare ID - Type Unspecified