Individual
KENRIC ALLEN MAYNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.P.H.
Contact information
Practice address
1000 E MOUNTAIN DR, WILKES BARRE, PA 18711-0027
(570) 826-7300
Mailing address
129 HUCKLEBERRY DR, DURYEA, PA 18642-1153
(570) 826-7300
(570) 819-5647
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
D62818
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
408307500
—
MD
Enumeration date
05/08/2006
Last updated
08/21/2020
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