Provider Demographics
NPI:1942206651
Name:KING, KENNETH RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RAYMOND
Last Name:KING
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 1:2101 EXECUTIVE DR STE 56
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2416
Mailing Address - Country:US
Mailing Address - Phone:757-827-6298
Mailing Address - Fax:
Practice Address - Street 1:2101 EXECUTIVE DR
Practice Address - Street 2:TOWER BOX 56
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2404
Practice Address - Country:US
Practice Address - Phone:757-827-6298
Practice Address - Fax:757-838-0725
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA19887207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA214292OtherANTHEM
VA1326022880OtherGROUP NPI#
VA51401OtherOPTIMA
CN5602OtherRAILROAD MEDICARE GROUP #
VAC00003OtherMEDICARE GROUP #
VA042740OtherANTHEM
VA1942206651OtherINDIVIDUAL NPI#
VA51401OtherOPTIMA