Provider Demographics
NPI:1467637041
Name:KENNETH B. SINGLETON, M.D.
Entity Type:Organization
Organization Name:KENNETH B. SINGLETON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-296-3737
Mailing Address - Street 1:8501 LASALLE RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5914
Mailing Address - Country:US
Mailing Address - Phone:410-296-3737
Mailing Address - Fax:410-296-0650
Practice Address - Street 1:8501 LASALLE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5914
Practice Address - Country:US
Practice Address - Phone:410-296-3737
Practice Address - Fax:410-296-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD830LMedicare UPIN