Provider Demographics
NPI:1093739039
Name:BLANK, KENNETH ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALAN
Last Name:BLANK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:2120 L ST NW STE 700
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1543
Practice Address - Country:US
Practice Address - Phone:202-331-9293
Practice Address - Fax:410-584-1739
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-09-15
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Provider Licenses
StateLicense IDTaxonomies
DC14263207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E36482Medicare UPIN