Provider Demographics
NPI:1144244112
Name:ELLINGTON, KENNETH RAYNOR (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:RAYNOR
Last Name:ELLINGTON
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 1:76 PEACHTREE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3505
Mailing Address - Country:US
Mailing Address - Phone:828-398-5244
Mailing Address - Fax:828-398-5223
Practice Address - Street 1:76 PEACHTREE RD STE 300
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3505
Practice Address - Country:US
Practice Address - Phone:828-398-5244
Practice Address - Fax:828-398-5223
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38935207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08931236Medicaid
NC8930368Medicaid
SCQ38935Medicaid
MS050001853Medicare PIN
SCE67555Medicare UPIN
NC8930368Medicaid
NC8930368Medicaid