Provider Demographics
NPI:1033320619
Name:MAFFET, CHARLES KENNY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KENNY
Last Name:MAFFET
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 1:1117 CAVE RUN LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-5541
Mailing Address - Country:US
Mailing Address - Phone:270-872-7105
Mailing Address - Fax:
Practice Address - Street 1:105 DIECKS DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2444
Practice Address - Country:US
Practice Address - Phone:270-737-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15586207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4444056018002Medicaid
KY4444056018002Medicaid
KY6331Medicare UPIN