Active NPI
David Lawrence Kettl, MD
- Pediatrics Physician
- North Potomac, MD
National Provider Identifier
1730264706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- D31677
- Practice address
- 12017 Citrus Grove Rd
North Potomac, MD 20878-4913 - Phone
- (301) 796-2105
- Fax
- (301) 796-9895
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D31677 | MD | Primary |
Addresses
Primary practice location
12017 Citrus Grove Rd
North Potomac, MD 20878-4913
Mailing address
12017 Citrus Grove Rd
North Potomac, MD 20878-4913
Phone (301) 796-2105
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D31677 | MD | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730264706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12017 CITRUS GROVE RD",
"city": "NORTH POTOMAC",
"state": "MD",
"postal_code": "208784913",
"telephone_number": "301-796-2105",
"fax_number": "301-796-9895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12017 CITRUS GROVE RD",
"city": "NORTH POTOMAC",
"state": "MD",
"postal_code": "208784913",
"telephone_number": "301-796-2105",
"fax_number": "301-796-9895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETTL",
"first_name": "DAVID",
"middle_name": "LAWRENCE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "D31677",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Potomac, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.