Individual
DR. KENNETH A WIDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1241 N MAIN ST, HARRISONBURG, VA 22802-4632
(540) 434-1941
(540) 433-8277
Mailing address
6040 PUBLIC LANDING ROAD, SNOW HILL, MD 21863
(410) 632-1100
(410) 632-2476
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0101041002
VA
2084P0804X
Child & Adolescent Psychiatry Physician
0101041002
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945166
—
VA
01
—
084255
SENTARA OPTIMA
VA
01
—
216331000
MAGELLAN
VA
01
—
258840
ANTHEM
VA
01
—
A164832
VALUE OPTIONS
VA
Enumeration date
08/03/2005
Last updated
06/06/2017
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