Provider Demographics
NPI:1457389637
Name:KEMBLE, MARK ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:KEMBLE
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 1:223 ADLEY WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6511
Mailing Address - Country:US
Mailing Address - Phone:864-907-8412
Mailing Address - Fax:
Practice Address - Street 1:245 PARKWAY E
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-9489
Practice Address - Country:US
Practice Address - Phone:864-661-1539
Practice Address - Fax:864-641-6647
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC571004971012OtherBCBS OF SC
SC80109540OtherRR MEDICARE
SC4394471OtherAETNA
SC9576433OtherCIGNA
SC154790Medicaid
SC80109540OtherRR MEDICARE
SC154790Medicaid