Provider Demographics
NPI:1568501856
Name:CHAMBERS, KENNETH H (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:H
Last Name:CHAMBERS
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 1:1406 BEATTIES FORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-4550
Mailing Address - Country:US
Mailing Address - Phone:704-344-0301
Mailing Address - Fax:704-377-5063
Practice Address - Street 1:1406 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-4550
Practice Address - Country:US
Practice Address - Phone:704-344-0301
Practice Address - Fax:704-377-5063
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11779207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8921895Medicaid
NC21895OtherBCBS