Provider Demographics
NPI:1730111634
Name:SKOLNICK, KENNETH BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:BRIAN
Last Name:SKOLNICK
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 1:119 ROCK HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1879
Mailing Address - Country:US
Mailing Address - Phone:412-531-1862
Mailing Address - Fax:412-531-6847
Practice Address - Street 1:4955 STEUBENVILLE PIKE STE 200
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-9604
Practice Address - Country:US
Practice Address - Phone:412-788-0444
Practice Address - Fax:412-788-0434
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016652E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0680185Medicaid
PA0680185Medicaid
PAB33582Medicare UPIN