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General NPI Number Information
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NPI Number | 1619057478
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Entity Type | Individual
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Provider Name | KENNETH CHARLES ULLMAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5410 CONNECTICUT AVE # 107
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City | NW WASHINGTON
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State | DC
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Zip | 20015
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Country | US
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Telephone | 202-686-1498
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Fax | 201-718-3475
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Provider Business Mailing Address
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Address Line | 5630 WISCONSIN AVENUE SUITE 304
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City | CHEVY CHASE
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State | MD
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Zip | 20815
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Country | US
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Telephone | 301-718-3474
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Fax | 301-718-3475
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25650
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D02586
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101024781
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License Number State | VA
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