Provider Demographics
NPI:1740210814
Name:KAHAN, BRIAN SCOT (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SCOT
Last Name:KAHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 JENNIFER RD STE 240
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7995
Mailing Address - Country:US
Mailing Address - Phone:410-571-9000
Mailing Address - Fax:410-266-1507
Practice Address - Street 1:170 JENNIFER RD STE 240
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7995
Practice Address - Country:US
Practice Address - Phone:410-571-9000
Practice Address - Fax:410-266-1507
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00538003261QP3300X
MDH53803208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD103199600Medicaid
MD320M43FMedicare PIN
MD103199600Medicaid