Individual
DR. KENNETH A VESELICKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 STADIUM DR, MORGANTOWN, WV 26506-7911
(304) 598-4000
(304) 293-6963
Mailing address
PO BOX 897, MORGANTOWN, WV 26507-0897
(304) 293-7401
(304) 293-6963
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
20302
WV
2085R0202X
Diagnostic Radiology Physician
Primary
20302
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010155321
—
VA
05
—
1008302580001
—
PA
05
—
1809613000
—
WV
05
—
2418315
—
OH
05
—
402620900
—
MD
05
—
64069263
—
KY
05
—
7615065
—
NC
01
—
P00345382
RAILROAD MEDICARE
WV
Enumeration date
03/23/2006
Last updated
04/15/2022
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