Provider Demographics
NPI:1376877308
Name:TONY P. KANNARKAT. MD. PA
Entity Type:Organization
Organization Name:TONY P. KANNARKAT. MD. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:PAPPACHAN
Authorized Official - Last Name:KANNARKAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-587-5090
Mailing Address - Street 1:8201 16TH ST
Mailing Address - Street 2:SUITE 121 BLAIR HOUSE
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3240
Mailing Address - Country:US
Mailing Address - Phone:301-587-5090
Mailing Address - Fax:301-587-8045
Practice Address - Street 1:8201 16TH ST
Practice Address - Street 2:SUITE 121 BLAIR HOUSE
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3240
Practice Address - Country:US
Practice Address - Phone:301-587-5090
Practice Address - Fax:301-587-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty