Provider Demographics
NPI:1023082633
Name:HUBER, KENNETH C (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:HUBER
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 1:11676 PERRY HWY
Mailing Address - Street 2:SUITE 1304
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7201
Mailing Address - Country:US
Mailing Address - Phone:724-935-6633
Mailing Address - Fax:724-935-2600
Practice Address - Street 1:11676 PERRY HWY
Practice Address - Street 2:SUITE 1304
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7201
Practice Address - Country:US
Practice Address - Phone:724-935-6633
Practice Address - Fax:724-935-2600
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA038716E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011105620005Medicaid
PA060024001OtherPALMETTO RAILROAD MEDICARE
PAB42288Medicare UPIN
PA757916Medicare PIN