MEDICARE: MR. KENNETH H. NOLL CO, C.PED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	12025890	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MK07AM	OTHER	MD	CAREFIRST
2	F725	OTHER	MD	CAREFIRST

General Provider Information

NPI Number	:	1891799870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH H. NOLL CO, C.PED.

Provider Business Mailing Address
First Line	:	2135 HAMPTON CT
Second Line	:
City	:	FALLSTON
State	:	MD
Zip	:	21047-2020
Country	:	US
Telephone Number	:	410-877-4160
Fax Number	:	410-877-0694

Provider Business Practice Location Address
First Line	:	2135 HAMPTON CT
Second Line	:
City	:	FALLSTON
State	:	MD
Zip	:	21047-2020
Country	:	US
Telephone Number	:	410-877-4160
Fax Number	:	410-877-0694

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/08/2007

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