Provider Demographics
NPI:1043266059
Name:SHUMAN, KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:SHUMAN
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 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-868-5080
Mailing Address - Fax:603-868-7440
Practice Address - Street 1:36 MADBURY RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-2021
Practice Address - Country:US
Practice Address - Phone:603-868-5080
Practice Address - Fax:603-868-7440
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11939207Q00000X
MEMD16159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076101Medicaid
ME1043266059Medicaid
NH3076101Medicaid
NHMM005701Medicare PIN
ME281720099Medicaid