Provider Demographics
NPI:1528061074
Name:KARLIN, KENNETH MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:MICHAEL
Last Name:KARLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 TOWN CENTER DR
Mailing Address - Street 2:STE 317
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3239
Mailing Address - Country:US
Mailing Address - Phone:703-437-3900
Mailing Address - Fax:703-437-9426
Practice Address - Street 1:1800 TOWN CENTER DR
Practice Address - Street 2:STE 317
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3239
Practice Address - Country:US
Practice Address - Phone:703-437-3900
Practice Address - Fax:703-437-9426
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101037922207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA027283OtherANTHEM
VA0800026OtherUNITED HEALTHCARE
VA6396143Medicaid
VA4086959OtherAETNA
VA4086959OtherAETNA
VAC61818Medicare UPIN