Provider Demographics
NPI:1629019211
Name:FOX, KENNETH EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EDWARD
Last Name:FOX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 FROSTY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-2404
Mailing Address - Country:US
Mailing Address - Phone:215-949-6622
Mailing Address - Fax:215-949-8357
Practice Address - Street 1:1310 FROSTY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-2404
Practice Address - Country:US
Practice Address - Phone:215-949-6622
Practice Address - Fax:215-949-8357
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009138-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG77260Medicare UPIN
PA014241Medicare ID - Type Unspecified