Provider Demographics
NPI:1346432028
Name:MINTON, KENNETH WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WALTER
Last Name:MINTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:WALTER
Other - Last Name:MINTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14101 ROBCASTE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1471
Mailing Address - Country:US
Mailing Address - Phone:301-455-5736
Mailing Address - Fax:443-689-2175
Practice Address - Street 1:14101 ROBCASTE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21131-1471
Practice Address - Country:US
Practice Address - Phone:013-455-5736
Practice Address - Fax:443-689-2175
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028651207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology