Provider Demographics
NPI:1891799870
Name:NOLL, KENNETH H (CO, CPED)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:H
Last Name:NOLL
Suffix:
Gender:M
Credentials:CO, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2020
Mailing Address - Country:US
Mailing Address - Phone:410-877-4160
Mailing Address - Fax:410-877-0694
Practice Address - Street 1:2135 HAMPTON CT
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2020
Practice Address - Country:US
Practice Address - Phone:410-877-4160
Practice Address - Fax:410-877-0694
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12025890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMK07AMOtherCAREFIRST
MDF725OtherCAREFIRST
MDF725OtherCAREFIRST