Provider Demographics
NPI:1992773964
Name:RICTOR, KENNETH WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WAYNE
Last Name:RICTOR
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:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17254-0398
Mailing Address - Country:US
Mailing Address - Phone:717-267-3606
Mailing Address - Fax:717-267-0443
Practice Address - Street 1:3730 SCOTLAND ROAD
Practice Address - Street 2:
Practice Address - City:SCOTLAND
Practice Address - State:PA
Practice Address - Zip Code:17254-0398
Practice Address - Country:US
Practice Address - Phone:717-267-3606
Practice Address - Fax:717-267-0443
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036568-E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC34564Medicare UPIN
PA478898LJ3Medicare PIN