Provider Demographics
NPI:1295873511
Name:ROBBINS, KENNETH X
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:X
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11305 ROUEN DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3127
Mailing Address - Country:US
Mailing Address - Phone:703-379-2600
Mailing Address - Fax:301-299-2986
Practice Address - Street 1:5055 SEMINARY RD
Practice Address - Street 2:SUITE 108
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-2034
Practice Address - Country:US
Practice Address - Phone:703-379-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD152842084P0800X
VA01010216642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
R0163960Medicare ID - Type Unspecified