Provider Demographics
NPI:1306976949
Name:ABBOTT, KENNETH LAURON (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LAURON
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HOSPITAL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4043
Mailing Address - Country:US
Mailing Address - Phone:410-414-9116
Mailing Address - Fax:410-414-9118
Practice Address - Street 1:110 HOSPITAL RD STE 105
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4043
Practice Address - Country:US
Practice Address - Phone:410-414-9116
Practice Address - Fax:410-414-9118
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56024207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD483400300Medicaid
830007961OtherMEDICARE RAILROAD
MD483400300Medicaid
MDH48712Medicare UPIN