Provider Demographics
NPI:1730289133
Name:ABBOTT, KEVIN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CHARLES
Last Name:ABBOTT
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 1:7 RUDIS WAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1143
Mailing Address - Country:US
Mailing Address - Phone:202-782-6462
Mailing Address - Fax:202-782-0185
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-0333
Practice Address - Fax:202-877-0341
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD210011409207RN0300X
GA031374286500000X, 171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No286500000XHospitalsMilitary Hospital
No171000000XOther Service ProvidersMilitary Health Care Provider