Individual
MARK C KENAMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2000 EOFF ST, WHEELING, WV 26003-3823
(304) 234-0123
Mailing address
PO BOX 6825, WHEELING, WV 26003-0663
(866) 684-1493
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
15817
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0118422000
—
WV
05
—
0153659
—
OH
05
—
02100530
—
NY
01
—
1036214
WORKERS COMP PIN NUMBER
WV
01
—
11101575
CAQH
WV
Enumeration date
07/27/2005
Last updated
07/18/2007
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