Provider Demographics
NPI:1760449136
Name:ASHLEY, KENNETH F (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:F
Last Name:ASHLEY
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 1:1462 ERIE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1026
Mailing Address - Country:US
Mailing Address - Phone:518-243-1500
Mailing Address - Fax:
Practice Address - Street 1:1101 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2425
Practice Address - Country:US
Practice Address - Phone:518-243-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131933207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY589101OtherBLUE CROSS
NY050922000005OtherFIDELIS
NY10024351OtherCDPHP
NY10503622OtherCAQH
NY924015OtherMVP
NY4799821OtherGHI-PPO
NY000000046371OtherGHI-HMO
NY5192147OtherAETNA
NY000472123001OtherBLUE SHIELD
NYE98489Medicare UPIN
NYS70822Medicare ID - Type Unspecified