Basic Information
Provider Information
NPI: 1558455808
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KARB
FirstName: KENNETH
MiddleName: SAMUEL
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2150 NC HIGHWAY 65
Address2:  
City: REIDSVILLE
State: NC
PostalCode: 273209609
CountryCode: US
TelephoneNumber: 3364279022
FaxNumber: 3364279030
Practice Location
Address1: 2150 NC HIGHWAY 65
Address2:  
City: REIDSVILLE
State: NC
PostalCode: 273209609
CountryCode: US
TelephoneNumber: 3364279022
FaxNumber: 3364279030
Other Information
ProviderEnumerationDate: 10/03/2006
LastUpdateDate: 06/21/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/21/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X22485NCN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RH0003X22485NCN Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
207RX0202X22485NCY Allopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology

ID Information
IDTypeStateIssuerDescription
2622301NCMEDCOSTOTHER
448701NCPARTNERS MEDICAREOTHER
427550801NCAETNAOTHER
894781105NC MEDICAID
4781101NCBCBS NCOTHER


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