Individual
DR. KENNETH WILLIAM DEFONTES III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8322 BELLONA AVE STE 100, TOWSON, MD 21204
(410) 337-7900
(410) 337-5321
Mailing address
8322 BELLONA AVE STE 100, TOWSON, MD 21204-2065
(410) 337-7900
(410) 337-5321
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
D0084939
MD
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
D0084939
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D0084939
MARYLAND LICENSE
MD
Enumeration date
06/22/2011
Last updated
08/01/2018
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