Individual
BEN W KITTREDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6355 WALKER LANE, SUITE 202, ALEXANDRIA, VA 22310-3257
(703) 810-5210
(703) 810-5418
Mailing address
PO BOX 75868, BALTIMORE, MD 21275-5868
(703) 383-6469
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101055642
VA
207X00000X
Orthopaedic Surgery Physician
D51741
MD
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
D51741
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6408028
—
VA
01
—
D51741
MARYLAND MEDICAL LICENSE
MD
01
—
M77089
CONTROLLED SUBSTANCE LICENSE
MD
Enumeration date
07/18/2006
Last updated
03/07/2023
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