Individual
KENNETH E MARNOCHA
Active
Individual
KENNETH E MARNOCHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01031076A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000202120
ANTHEM PROVIDER NUMBER
IN
05
—
100320630
—
IN
01
—
10825542
CAQH NUMBER
IN
01
—
156682
PHCS PID NUMBER
IN
Enumeration date
03/15/2006
Last updated
09/17/2014
Update your record
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