Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 0101055642 | VA |
N | 207X00000X | Orthopaedic Surgeon | D51741 | MD |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | D51741 | MD |
NPI | 1134147978 |
---|---|
Provider Name | Ben W Kittredge |
First Address | Baltimore, MD 21275-5868 |
Second Address | Alexandria, VA 22310-3257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 02/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6408028 | (05) | VA |
D51741 | MARYLAND MEDICAL LICENSE (01) | MD |
FK3672436 | MARYLAND DEA LICENSE (01) | MD |
G69161 | (02) | |
M77089 | CONTROLLED SUBSTANCE LICENSE (01) | MD |