Healthcare Provider Details

I. General information

NPI: 1235314436
Provider Name (Legal Business Name): KENNETH S VILLAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14090 HG TRUEMAN RD SUITE 2100
SOLOMONS MD
20688
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 410-394-3712
  • Fax: 410-394-3714
Mailing address:
  • Phone: 410-933-5412
  • Fax: 410-933-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0067495
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: