Provider Demographics
NPI:1275532830
Name:UNICE, KENNETH (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:UNICE
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 1:495 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2974
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:495 PINE ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2974
Practice Address - Country:US
Practice Address - Phone:814-333-2103
Practice Address - Fax:814-337-3798
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004179L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006131730003Medicaid
PA0006131730003Medicaid
PA105668Medicare ID - Type Unspecified