Provider Demographics
NPI:1942206628
Name:KENNEL, ELMER (MD)
Entity Type:Individual
Prefix:
First Name:ELMER
Middle Name:
Last Name:KENNEL
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:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-433-2351
Mailing Address - Fax:
Practice Address - Street 1:3320 EMMAUS RD
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-2685
Practice Address - Country:US
Practice Address - Phone:540-433-2351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026439208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007359748Medicaid
VAC05754OtherMEDICARE GROUP PTAN
WV012804000Medicaid
VA082160OtherSOUTHERN HEALTH
VA034941OtherANTHEM BCBS
WV012804000Medicaid