Provider Demographics
NPI:1396718755
Name:GEH, KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:GEH
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:PO BOX 1280
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21041-1280
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 ARMORY PL
Practice Address - Street 2:SUITE 3G
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4603
Practice Address - Country:US
Practice Address - Phone:410-225-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2745223OtherAETNA HEALTH PLAN
MD007201000Medicaid
MD298110OtherOPTIMUM CHOICE
MD022803OtherPRIORITY PARTNERS
MD49391OtherAMERIGROUP
MDF081-0001OtherCAREFIRST BLUE CHOICE
MDLW11GEOtherMD BLUESHIELD
MD04-04411OtherUNITED HEALTHCARE
MD2783OtherELDERHEALTH
MDF081-0001OtherCAREFIRST BLUE CHOICE
MD2745223OtherAETNA HEALTH PLAN
MD110231464Medicare PIN