Healthcare Provider Details

I. General information

NPI: 1821352113
Provider Name (Legal Business Name): KINAN KNAISH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8813 WALTHAM WOODS ROAD SUITE 204
PARKVILLE MD
21234
US

IV. Provider business mailing address

500 GYPSY LN
YOUNGSTOWN OH
44504-1315
US

V. Phone/Fax

Practice location:
  • Phone: 410-661-4670
  • Fax:
Mailing address:
  • Phone: 347-294-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0078396
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: