Individual
KENNETH EDGAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
373 MCCOMBS RD, VENETIA, PA 15367-1342
(855) 687-7237
Mailing address
4040 E CAMELBACK RD STE 250, PHOENIX, AZ 85018-8350
(855) 687-7237
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101253287
VA
2085R0202X
Diagnostic Radiology Physician
Primary
MD065024L
PA
2085R0202X
Diagnostic Radiology Physician
T3273
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000268720
BC BS
PA
05
—
0016916930001
—
PA
05
—
2612622
—
OH
01
—
300084169
RAILROAD MEDICARE
PA
Enumeration date
07/12/2005
Last updated
03/18/2026
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