Provider Demographics
NPI:1407886708
Name:CANNARD, KEVIN ROBERTSON (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ROBERTSON
Last Name:CANNARD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:NEUROLOGY WALTER REED NAT MIL MED CTR
Mailing Address - Street 2:8901 WISCONSIN AVE.
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0001
Mailing Address - Country:US
Mailing Address - Phone:301-295-4771
Mailing Address - Fax:301-295-4759
Practice Address - Street 1:NEUROLOGY WALTER REED NAT MIL MED CTR
Practice Address - Street 2:8901 WISCONSIN AVE.
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-295-4771
Practice Address - Fax:301-295-4759
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-10-29
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Provider Licenses
StateLicense IDTaxonomies
GA043343208U00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BC8935578OtherDEA NO