Individual provider Active NPI

Kenneth Michael Klebanow, M.D.

  • Pediatrics Physician
  • Columbia, MD
National Provider Identifier
1619989407
Registry record updated Feb 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D0026274 Issued in MD
Practice address
8821 Columbia 100 Pkwy
Columbia, MD 21045-2168
Phone
(410) 715-0080
Fax
(410) 730-6198
NPI assigned
Aug 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X D26274 MD
Pediatrics Physician 208000000X D0026274 MD Primary

Addresses

Primary practice location

8821 Columbia 100 Pkwy
Columbia, MD 21045-2168

Mailing address

8821 Columbia 100 Pkwy
Columbia, MD 21045-2168
Phone (410) 715-0080

Other identifiers 1

IdentifierTypeStateIssuer
136461800MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110915000166 MD Practitioner - Pediatric Medicine 5092991059

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Frederick Health Hospital Inc Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771459200000",
    "number": "1619989407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8821 COLUMBIA 100 PKWY",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452168",
            "telephone_number": "410-715-0080",
            "fax_number": "410-730-6198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8821 COLUMBIA 100 PKWY",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452168",
            "telephone_number": "410-715-0080",
            "fax_number": "410-730-6198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLEBANOW",
        "first_name": "KENNETH",
        "middle_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2026-02-19",
        "certification_date": "2026-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "MD",
            "license": "D26274",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0026274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136461800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

Verify at the official NPI Registry.