MEDICARE: DR. KENNETH LAMAR BRYANT MD

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	207R00000X	Internal Medicine Physician	82321	CT
2	207R00000X	Internal Medicine Physician	ME169539	FL
3	207R00000X	Internal Medicine Physician	331745	NY
4	207R00000X	Internal Medicine Physician	MD492974	PA
5	207R00000X	Internal Medicine Physician	25MA12314900	NJ
6	207R00000X	Internal Medicine Physician	101585	GA
7	208M00000X	Hospitalist Physician	MD492974	PA

General Provider Information

NPI Number	:	1912587510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH LAMAR BRYANT MD

Provider Business Mailing Address
First Line	:	250 CLARKSON AVE APT 319
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-8517
Country	:	US
Telephone Number	:	305-336-5346
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 CLARKSON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-2185
Country	:	US
Telephone Number	:	305-336-5346
Fax Number	:

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

Provider Enumeration Date	:	04/09/2021
Last Update Date	:	12/19/2025

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