Individual
DR. KENNETH D PEARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 N MAPLEMERE RD STE 120, WILLIAMSVILLE, NY 14221-3178
(716) 836-4646
(716) 836-4696
Mailing address
111 N MAPLEMERE RD STE 120, WILLIAMSVILLE, NY 14221-3178
(716) 836-4646
(716) 836-4696
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
181834
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00025335602
UNIVERA
—
01
—
00025335605
UNIVERA
—
01
—
000911558011
BLUE SHIELD WNY
—
01
—
000911558015
BLUE SHIELD WNY
—
05
—
01230148
—
NY
01
—
0142865
GHI
—
01
—
04026003061
FIDELIS
—
01
—
101326FF
PREFERRED CARE
—
01
—
1693149
INDEPENDENT HEALTH
—
01
—
1818343B
WORKERS COMPENSATION
NY
01
—
4195929
GHI
—
01
—
P00005729
RR MEDICARE
—
01
—
P010181834
BLUE CHOICE
—
01
—
P020181834
BLUE SHIELD ROCHESTER
—
Enumeration date
04/21/2006
Last updated
08/21/2023
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