Provider Demographics
NPI:1730167776
Name:CHOQUETTE, KENNETH J (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:CHOQUETTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-439-1662
Mailing Address - Fax:
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:STE 203
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-439-1662
Practice Address - Fax:610-439-8397
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007819L208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001303012Medicaid
PAE53229Medicare UPIN
PA603523NEZMedicare ID - Type Unspecified