Healthcare Provider Details

I. General information

NPI: 1972611051
Provider Name (Legal Business Name): STEPHEN LEIGH KINNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WISCONSIN CIR STE 700
CHEVY CHASE MD
20815-7007
US

IV. Provider business mailing address

2 WISCONSIN CIR STE 700
CHEVY CHASE MD
20815-7007
US

V. Phone/Fax

Practice location:
  • Phone: 202-368-6820
  • Fax: 202-370-6945
Mailing address:
  • Phone: 202-368-6820
  • Fax: 202-370-6945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberD0037617
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD19758
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: