Provider Demographics
NPI:1457498883
Name:WRIGHT, KENNETH CARR (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:CARR
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MORRIS ST
Mailing Address - Street 2:CAMC GENERAL HOSPITAL
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1326
Mailing Address - Country:US
Mailing Address - Phone:304-388-6301
Mailing Address - Fax:304-388-7864
Practice Address - Street 1:501 MORRIS ST
Practice Address - Street 2:CAMC GENERAL HOSPITAL
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1326
Practice Address - Country:US
Practice Address - Phone:304-388-6301
Practice Address - Fax:304-388-7864
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15060208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0113139000Medicaid
AW1335771OtherDEA
WR7111761Medicare ID - Type Unspecified
WV0113139000Medicaid