Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 14263 | DC |
NPI | 1093739039 |
---|---|
Provider Name | Dr. Kenneth Alan Blank |
First Address | Fulton, MD 20759-2694 |
Second Address | Washington, DC 20037-1810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 13/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E36482 | (02) |