Provider Demographics
NPI:1912587510
Name:BRYANT, KENNETH LAMAR (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LAMAR
Last Name:BRYANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 CLARKSON AVE APT 319
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-8517
Mailing Address - Country:US
Mailing Address - Phone:305-336-5346
Mailing Address - Fax:
Practice Address - Street 1:250 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2185
Practice Address - Country:US
Practice Address - Phone:305-336-5346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME169539207R00000X
NJ25MA12314900207R00000X
GA101585207R00000X
NY331745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine