Provider Demographics
NPI:1861459802
Name:PRICE, KENNETH OWEN (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:OWEN
Last Name:PRICE
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 1:170 MANNING DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4221
Mailing Address - Country:US
Mailing Address - Phone:919-966-8804
Mailing Address - Fax:919-843-6520
Practice Address - Street 1:170 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-2181
Practice Address - Country:US
Practice Address - Phone:919-966-8804
Practice Address - Fax:919-843-6520
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001255207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891338NMedicaid
NC2015640Medicare ID - Type Unspecified
NC891338NMedicaid
VA002039R26Medicare PIN