Individual
MR. KENNETH SCRUGGS MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1522
(336) 768-3361
(336) 768-4131
Mailing address
110 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1522
(336) 768-3361
(336) 768-4131
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
9500660
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040015067
RAILROAD MEDICARE
NC
01
—
1001971
UNITED HEALTHCARE
NC
01
—
54268
MEDCOST
NC
01
—
55051
BLUE CROSS BLUE SHIELD
NC
01
—
6502393
VIRGINIA MEDICAID
NC
05
—
8955051
—
NC
01
—
9881
PARTNERS
NC
Enumeration date
01/18/2006
Last updated
02/15/2012
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