Provider Demographics
NPI:1598080541
Name:RADFORD, KENNETT DARREL II (PHD, CRNA)
Entity Type:Individual
Prefix:DR
First Name:KENNETT
Middle Name:DARREL
Last Name:RADFORD
Suffix:II
Gender:M
Credentials:PHD, CRNA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2481 LLEWELLYN AVE SUITE 5800
Mailing Address - Street 2:
Mailing Address - City:FORT GEORGE S. MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-5129
Mailing Address - Country:US
Mailing Address - Phone:301-677-8931
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE STE 1620
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4322
Practice Address - Country:US
Practice Address - Phone:301-718-9800
Practice Address - Fax:301-986-1672
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024168740367500000X
MDR230515367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered