Individual
KENNETH TELLERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
711 W 40TH ST STE 438, BALTIMORE, MD 21211-2199
(410) 243-8632
(410) 243-0470
Mailing address
2416 KEN OAK RD, BALTIMORE, MD 21209-4310
(410) 664-6632
(410) 243-0470
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
D0025147
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
350701700
—
MD
Enumeration date
10/03/2005
Last updated
09/15/2021
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