Basic Information
| Provider Information | |||||||||
| NPI: | 1912975640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COMPTON | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7048388494 | ||||||||
| Practice Location | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7048388494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 30314 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 1040933 | 01 | NC | UNITED HEALTHCARE | OTHER | 22327 | 01 | NC | MEDCOST | OTHER | N30314 | 05 | SC | MEDICAID | 141028 | 01 | NC | COVENTRY HEALTHCARE | OTHER | 24225 | 01 | NC | PARTNERS | OTHER | 4255325 | 01 | AETNA | OTHER | 776811 | 01 | SC | WELLCARE | OTHER | 33490 | 01 | NC | WELLPATH | OTHER | 7923868 | 05 | NC | MEDICAID | 23868 | 01 | NC | BCBS | OTHER | 20095478 | 01 | SC | SELECT HEALTH OF SC | OTHER | 276561 | 01 | NC | MAMSI | OTHER |