Provider Demographics
NPI:1619949120
Name:NOEL, KENNETH R (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:NOEL
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 1:881 HOSPITAL RD
Mailing Address - Street 2:CENTER FOR PAIN MANAGEMENT
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3629
Mailing Address - Country:US
Mailing Address - Phone:724-357-8135
Mailing Address - Fax:724-357-8138
Practice Address - Street 1:881 HOSPITAL RD
Practice Address - Street 2:CENTER FOR PAIN MANAGEMENT
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3629
Practice Address - Country:US
Practice Address - Phone:724-357-8135
Practice Address - Fax:724-357-8138
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424963207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1676359OtherHIGHMARK
1676359OtherHIGHMARK
A90526Medicare UPIN