Provider Demographics
NPI:1679252597
Name:ALFORD, KENT LEON (RN)
Entity type:Individual
Prefix:MR
First Name:KENT
Middle Name:LEON
Last Name:ALFORD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11100 BILLINGSLEY RD
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3400
Mailing Address - Country:US
Mailing Address - Phone:202-509-5374
Mailing Address - Fax:
Practice Address - Street 1:11100 BILLINGSLEY RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3400
Practice Address - Country:US
Practice Address - Phone:202-509-5374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00012293732083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty