Provider Demographics
NPI:1073573929
Name:HIGGINS, KENNETH ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ROBERT
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 S QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4947
Mailing Address - Country:US
Mailing Address - Phone:717-812-5888
Mailing Address - Fax:717-741-3709
Practice Address - Street 1:2471 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4947
Practice Address - Country:US
Practice Address - Phone:717-812-5888
Practice Address - Fax:717-741-3709
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005375L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010615750001Medicaid
D98800Medicare UPIN
472629JKMedicare ID - Type Unspecified