Provider Demographics
NPI:1568437333
Name:KANOVSKY, MARTIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:S
Last Name:KANOVSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4401
Mailing Address - Country:US
Mailing Address - Phone:301-656-5050
Mailing Address - Fax:301-654-4237
Practice Address - Street 1:5530 WISCONSIN AVE STE 700
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4401
Practice Address - Country:US
Practice Address - Phone:301-656-5050
Practice Address - Fax:301-656-3168
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029229207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCB92838Medicare UPIN
DC680035Medicare ID - Type Unspecified