Provider Demographics
NPI:1326032863
Name:SUMMER, KENNETH V (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:V
Last Name:SUMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1455 25TH AVE DR. NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-9655
Mailing Address - Country:US
Mailing Address - Phone:828-322-4453
Mailing Address - Fax:828-324-9295
Practice Address - Street 1:1375 4TH STREET DR NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2523
Practice Address - Country:US
Practice Address - Phone:828-322-4453
Practice Address - Fax:828-324-9295
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC32439208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7980902Medicaid
NC7980902Medicaid