Provider Demographics
NPI:1306834379
Name:MCDOWELL, KENNETH MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MICHAEL
Last Name:MCDOWELL
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:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-0845
Mailing Address - Country:US
Mailing Address - Phone:540-371-4488
Mailing Address - Fax:
Practice Address - Street 1:125 OLDE GREENWICH DR
Practice Address - Street 2:SUITE 300
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4001
Practice Address - Country:US
Practice Address - Phone:540-374-5599
Practice Address - Fax:540-735-8097
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H86477Medicare UPIN
00W026C01Medicare PIN