Provider Demographics
NPI:1750342341
Name:KENAMOND, THOMAS G (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:KENAMOND
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 1:58 16TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3660
Mailing Address - Country:US
Mailing Address - Phone:304-242-7751
Mailing Address - Fax:304-242-7254
Practice Address - Street 1:58 16TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3660
Practice Address - Country:US
Practice Address - Phone:203-234-1751
Practice Address - Fax:304-242-1752
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052389207RN0300X
WV11166207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV11166BOtherHPUOV
WV0076890000Medicaid
WV000043718OtherMT ST BLUE CROSS BS
OH0434631Medicaid
OH0434631Medicaid
WV11166BOtherHPUOV