Provider Demographics
NPI:1841256765
Name:PARKER, KENNETH CARROLL (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CARROLL
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:CAROL
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:36 MCMILLEN DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1809
Mailing Address - Country:US
Mailing Address - Phone:220-564-4270
Mailing Address - Fax:220-564-4272
Practice Address - Street 1:36 MCMILLEN DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1809
Practice Address - Country:US
Practice Address - Phone:220-564-4270
Practice Address - Fax:220-564-4272
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-008826207YS0123X
OH35088266207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2676279Medicaid
OH2676279Medicaid