Provider Demographics
NPI:1700973344
Name:DESTIN, KISHA (MD)
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:
Last Name:DESTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9901 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3357
Mailing Address - Country:US
Mailing Address - Phone:240-826-7488
Mailing Address - Fax:240-826-5388
Practice Address - Street 1:9901 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:240-826-7488
Practice Address - Fax:240-826-5388
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2018-11-15
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Provider Licenses
StateLicense IDTaxonomies
MDD0068218208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics