Healthcare Provider Details

I. General information

NPI: 1841256765
Provider Name (Legal Business Name): KENNETH CARROLL PARKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KENNETH CAROL PARKER M.D.

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/24/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MCMILLEN DR
NEWARK OH
43055-1809
US

IV. Provider business mailing address

36 MCMILLEN DR
NEWARK OH
43055-1809
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4270
  • Fax: 220-564-4272
Mailing address:
  • Phone: 220-564-4270
  • Fax: 220-564-4272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number35-008826
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number35088266
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: