Provider Demographics
NPI:1518966258
Name:LENNON, KENNETH CHARLES (MD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:CHARLES
Last Name:LENNON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2536
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:611 N LINDSAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4300
Practice Address - Country:US
Practice Address - Phone:336-802-2250
Practice Address - Fax:336-802-2251
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2015-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200000515207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00435200OtherRAILROAD MEDICARE
NC89126UTMedicaid
NC89126UTMedicaid
NC2280608AMedicare PIN
NCH16409Medicare UPIN