Provider Demographics
NPI:1609822691
Name:TROFATTER, KENNETH FRANK JR (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:FRANK
Last Name:TROFATTER
Suffix:JR
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 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:890 W FARIS RD
Practice Address - Street 2:SUITE 470
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4247
Practice Address - Country:US
Practice Address - Phone:864-455-6444
Practice Address - Fax:864-455-3095
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23397207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC160057516OtherRR MEDICARE
SCQ18281Medicaid
SC160057516OtherRR MEDICARE
SCC363717951Medicare PIN
SCQ18281Medicaid
SCQ18281Medicaid
SCC363713640Medicare PIN
SCC36371Medicare UPIN