Provider Demographics
NPI:1316903073
Name:WILLIAMS, KENNETH LEE (MD)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 W CRESCENT PARK
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2111
Mailing Address - Country:US
Mailing Address - Phone:814-723-4973
Mailing Address - Fax:814-723-8952
Practice Address - Street 1:143 PLEASANT DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365
Practice Address - Country:US
Practice Address - Phone:814-726-3310
Practice Address - Fax:817-726-0295
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD029673E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
25212101OtherUNIERA
PA118477OtherBS
PA000972635Medicaid
080103633OtherPALMETTO
PA110565OtherMED PLUS