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General NPI Number Information
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NPI Number | 1457610875
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Entity Type | Individual
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Provider Name | KENNETH WALTER MCKINLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2012
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Last Update Date | 09/14/2018
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Provider Practice Location Address
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Address Line | 111 MICHIGAN AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20010
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Country | US
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Telephone | 202-476-4177
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Fax |
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Provider Business Mailing Address
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Address Line | 337 WEBSTER ST NW
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City | WASHINGTON
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State | DC
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Zip | 20011-7328
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Country | US
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Telephone | 570-594-5606
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 57008
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 57008
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | MD046009
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License Number State | DC
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