Provider Demographics
NPI:1972589935
Name:KOHAGEN, KENNETH RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RICHARD
Last Name:KOHAGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 ATRIUM DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6673
Mailing Address - Country:US
Mailing Address - Phone:919-791-2040
Mailing Address - Fax:919-791-2041
Practice Address - Street 1:2417 ATRIUM DR
Practice Address - Street 2:SUITE 150
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6673
Practice Address - Country:US
Practice Address - Phone:919-791-2040
Practice Address - Fax:919-791-2041
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-00546207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC94963OtherMEDCOST
NC100014396OtherRAILROAD MEDICARE
NC4510878OtherAETNA
NC49984OtherBCBS
NC6013465OtherCIGNA
NC2950429OtherUNITED
NC289330OtherMAMSI
NC8949984Medicaid
NC30622OtherPARTNERS
NC2950429OtherUNITED
NC8949984Medicaid