Individual
DR. KENNETH A. WIDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 N ACADEMY AVE, DANVILLE, PA 17822-2018
(570) 271-7149
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-3034
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD424958
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101032558
—
PA
Enumeration date
05/15/2006
Last updated
07/16/2020
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