Individual
MR. KENNY IMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.C.
Contact information
Practice address
111 DAVIS ST, SALISBURY, MD 21804-5032
(410) 749-4154
Mailing address
4014 OAKLAND SCHOOL RD, SALISBURY, MD 21804-2715
(410) 726-1576
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C0003072
MD
207P00000X
Emergency Medicine Physician
C50000664
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1066952
CERTIFICATION P.A.C.
MD
01
—
C0003072
P.A. LICENSE
MD
01
—
PA60330
LICENSE CONTROLLED SUBSTA
MD
Enumeration date
11/24/2006
Last updated
03/07/2023
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