Provider Demographics
NPI:1588616429
Name:RYDER, KENNETH G (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:G
Last Name:RYDER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1605 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:4955 ROUTE 873
Practice Address - Street 2:SUITE B
Practice Address - City:SCHNECKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18078-2265
Practice Address - Country:US
Practice Address - Phone:610-799-4100
Practice Address - Fax:484-403-4014
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD033810E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01054804OtherCAPITAL BLUE CROSS
PA080112252OtherPALMETTO GBA MEDICARE
PA463740OtherHIGHMARK PA BLUE SHIELD
PA01054804OtherCAPITAL BLUE CROSS
PA463740OtherHIGHMARK PA BLUE SHIELD
PA463740LH5Medicare PIN