Provider Demographics
NPI:1407059637
Name:FORE, KENNETH EDWARD II (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EDWARD
Last Name:FORE
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:1048 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4138
Mailing Address - Country:US
Mailing Address - Phone:276-783-1827
Mailing Address - Fax:276-783-2879
Practice Address - Street 1:1049 CLAYMONT DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4481
Practice Address - Country:US
Practice Address - Phone:343-582-1600
Practice Address - Fax:434-582-4807
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2018-04-30
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Provider Licenses
StateLicense IDTaxonomies
MI43010879442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA101475Medicare PIN