Provider Demographics
NPI:1932162856
Name:LEFLER, KENNETH DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DAVID
Last Name:LEFLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12005 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT ASHBY
Mailing Address - State:WV
Mailing Address - Zip Code:26719-9237
Mailing Address - Country:US
Mailing Address - Phone:304-597-1134
Mailing Address - Fax:304-597-1112
Practice Address - Street 1:167 S MINERAL ST
Practice Address - Street 2:POTOMAC VALLEY HOSPITAL ED
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2643
Practice Address - Country:US
Practice Address - Phone:304-597-1134
Practice Address - Fax:304-597-1112
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16453207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVB40101Medicare UPIN