Provider Demographics
NPI:1275608184
Name:FORD, KEVIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:FORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7404 EXECUTIVE PLACE
Mailing Address - Street 2:#501
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706
Mailing Address - Country:US
Mailing Address - Phone:301-220-0300
Mailing Address - Fax:301-474-8857
Practice Address - Street 1:7404 EXECUTIVE PL
Practice Address - Street 2:#501
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2268
Practice Address - Country:US
Practice Address - Phone:301-220-0300
Practice Address - Fax:301-474-8857
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD40222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF29681Medicare UPIN
MD000L13E60Medicare ID - Type Unspecified