Provider Demographics
NPI:1477509230
Name:HARSHBARGER, KENNETH G (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:G
Last Name:HARSHBARGER
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 1:5735 MEEKER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1180
Mailing Address - Country:US
Mailing Address - Phone:937-548-9680
Mailing Address - Fax:937-548-2087
Practice Address - Street 1:10484 KLEY RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:OH
Practice Address - Zip Code:45380-9561
Practice Address - Country:US
Practice Address - Phone:937-526-3016
Practice Address - Fax:937-526-3809
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.073093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2136021Medicaid
OH0882442Medicare PIN
OH2136021Medicaid