Provider Demographics
NPI:1992775977
Name:VERMETTE, KENNETH NORMAN (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:NORMAN
Last Name:VERMETTE
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 1:561 FAIRTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2412
Mailing Address - Country:US
Mailing Address - Phone:215-487-4000
Mailing Address - Fax:215-483-8187
Practice Address - Street 1:561 FAIRTHORNE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2412
Practice Address - Country:US
Practice Address - Phone:215-487-4000
Practice Address - Fax:215-483-8187
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0905207Q00000X
PAMD444355207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136600711Medicaid
TX136600711Medicaid
TXB27297Medicare UPIN