Provider Demographics
NPI:1295050227
Name:SURKIN, KENNETH HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HOWARD
Last Name:SURKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8920
Mailing Address - Fax:757-446-5242
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-446-5242
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101253291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1295050227OtherUNITED HEALTHCARE
VA-028OtherTRICARE/CHAMPUS
VAPAROtherVIRGINIA HEALTH NETWORK
VA1295050227OtherVIRGINIA PREMIER HEALTH PLAN
NC1295050227Medicaid
VA1295050227OtherCOVENTRY NETWORK
VAPAROtherCORVEL
VA10109255OtherOPTIMA HEALTH
VA1295050227Medicaid
VAPAROtherUSA MANAGED CARE
VAPAROtherMULTIPLAN
VAPAROtherCIGNA
VAPAROtherAETNA
VA493191OtherANTHEM BC/BS
VAPAROtherMULTIPLAN
VAPAROtherVIRGINIA HEALTH NETWORK