Provider Demographics
NPI:1487657383
Name:KORNETSKY, KENNETH M (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:KORNETSKY
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 1:406 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3026
Mailing Address - Country:US
Mailing Address - Phone:540-347-5696
Mailing Address - Fax:540-347-7152
Practice Address - Street 1:406 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3026
Practice Address - Country:US
Practice Address - Phone:540-347-5696
Practice Address - Fax:540-347-7152
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029628207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA144828OtherSOUTHERN HEALTH
VA655412OtherFIRST HEALTH
VA7213129002OtherCIGNA
VA033273OtherANTHEM WARRENTON
VA20744OtherUNICARE
VA23838OtherSENTARA
VA299000OtherMAMSI
VA503300OtherNCPPO
VA201511OtherANTHEM CULPEPER
VA6093485OtherVIRGINIA PREMIER
VA6093485Medicaid
VA41950001OtherCAREFIRST
VA0004087405OtherAETNA
VAB59625Medicare UPIN
VA23838OtherSENTARA