Provider Demographics
NPI:1518922608
Name:MINER, W KENNETH (PA)
Entity Type:Individual
Prefix:MR
First Name:W
Middle Name:KENNETH
Last Name:MINER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1579 STRAITS TURNPIKE
Mailing Address - Street 2:TURNPIKE OFFICE PARK
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762
Mailing Address - Country:US
Mailing Address - Phone:203-758-1272
Mailing Address - Fax:203-758-1070
Practice Address - Street 1:1579 STRAITS TURNPIKE
Practice Address - Street 2:TURNPIKE OFFICE PARK
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762
Practice Address - Country:US
Practice Address - Phone:203-598-0700
Practice Address - Fax:203-598-0076
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT000334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02444Medicare PIN