Provider Demographics
NPI:1154302826
Name:HASH, KENDALL S (MD)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:S
Last Name:HASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3225 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8060
Mailing Address - Country:US
Mailing Address - Phone:919-781-1050
Mailing Address - Fax:919-510-5090
Practice Address - Street 1:3225 BLUE RIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8060
Practice Address - Country:US
Practice Address - Phone:919-781-1050
Practice Address - Fax:919-510-5090
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93940207N00000X
MDD59888207N00000X
NC2010-01075207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H87768Medicare UPIN