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General NPI Number Information
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NPI Number | 1245271089
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Entity Type | Individual
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Provider Name | ALAN DAVID KORNBLUT MD FACS
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5530 WISCONSIN AVENUE SUITE 535
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City | CHEVY CHASE
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State | MD
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Zip | 20815-4451
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Country | US
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Telephone | 301-657-8834
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Fax |
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Provider Business Mailing Address
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Address Line | 5530 WISCONSIN AVENUE SUITE 535
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City | CHEVY CHASE
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State | MD
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Zip | 20815-4451
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Country | US
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Telephone | 301-657-8834
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | D26462
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 12426
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 0101032737
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License Number State | VA
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