Provider Demographics
NPI:1912975640
Name:COMPTON, KENNETH W (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:W
Last Name:COMPTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-838-8494
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-838-8494
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30314207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1040933OtherUNITED HEALTHCARE
NC22327OtherMEDCOST
SCN30314Medicaid
NC141028OtherCOVENTRY HEALTHCARE
NC24225OtherPARTNERS
4255325OtherAETNA
SC776811OtherWELLCARE
NC33490OtherWELLPATH
NC7923868Medicaid
NC23868OtherBCBS
SC20095478OtherSELECT HEALTH OF SC
NC276561OtherMAMSI
SC20095478OtherSELECT HEALTH OF SC
NC23868OtherBCBS
040013568Medicare ID - Type UnspecifiedRAILROAD