Provider Demographics
NPI:1952540296
Name:STABILE, KENNETH M (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:M
Last Name:STABILE
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 SAVANNAH HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-2225
Mailing Address - Country:US
Mailing Address - Phone:843-571-7300
Mailing Address - Fax:843-571-1080
Practice Address - Street 1:2065 SAVANNAH HWY
Practice Address - Street 2:SUITE C
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-2225
Practice Address - Country:US
Practice Address - Phone:843-571-7300
Practice Address - Fax:843-571-1080
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist