Provider Demographics
NPI:1952378788
Name:ROCK, KENNETH ALAN (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALAN
Last Name:ROCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:167 S MINERAL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-2643
Mailing Address - Country:US
Mailing Address - Phone:304-597-2040
Mailing Address - Fax:304-597-2042
Practice Address - Street 1:167 S MINERAL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2643
Practice Address - Country:US
Practice Address - Phone:304-597-2040
Practice Address - Fax:304-597-2042
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV02030208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D74411Medicare UPIN