Provider Demographics
NPI:1629851795
Name:EDGERTON, KENNETH JR (PROSTHETICSPECIALIST)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:EDGERTON
Suffix:JR
Gender:M
Credentials:PROSTHETICSPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 29TH ST NW APT 137
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-5535
Mailing Address - Country:US
Mailing Address - Phone:202-817-3688
Mailing Address - Fax:
Practice Address - Street 1:1604 7TH ST NW STE B
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3219
Practice Address - Country:US
Practice Address - Phone:202-515-8053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment