Basic Information
| Provider Information | |||||||||
| NPI: | 1619941747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORE | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | FRANCIS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5900 LAKE WRIGHT DR | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235021871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574668683 | ||||||||
| FaxNumber: | 7574668892 | ||||||||
| Practice Location | |||||||||
| Address1: | 1950 GLENN MITCHELL DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234560019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573680437 | ||||||||
| FaxNumber: | 7573680492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 12/01/2014 | ||||||||
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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 | 207RH0003X | 0101053645 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1619941747 | 05 | VA | MEDICAID | P01373557 | 01 | VA | RAILROAD MEDICARE | OTHER |