Provider Demographics
NPI:1003887019
Name:WOO, KENNETH ROGER (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ROGER
Last Name:WOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 ROCK SPRING RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2620
Mailing Address - Country:US
Mailing Address - Phone:410-879-4879
Mailing Address - Fax:
Practice Address - Street 1:2007 ROCK SPRING RD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2620
Practice Address - Country:US
Practice Address - Phone:410-879-4879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058566208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD986561602Medicaid
MD986561602Medicaid
MDH65687Medicare UPIN
MDE041Medicare ID - Type Unspecified