Basic Information
| Provider Information | |||||||||
| NPI: | 1407059637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORE | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1048 TERRACE DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767831827 | ||||||||
| FaxNumber: | 2767832879 | ||||||||
| Practice Location | |||||||||
| Address1: | 1049 CLAYMONT DR | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245024481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3435821600 | ||||||||
| FaxNumber: | 4345824807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 04/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 4301087944 | MI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.