Provider Demographics
NPI:1649374356
Name:POMPILIO, KENNETH JOHN (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:JOHN
Last Name:POMPILIO
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:303 WASHINGTON STREET
Mailing Address - Street 2:KENNETH J POMPILIO MD PA
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2828
Mailing Address - Country:US
Mailing Address - Phone:301-722-2200
Mailing Address - Fax:301-722-2206
Practice Address - Street 1:303 WASHINGTON STREET
Practice Address - Street 2:KENNETH J POMPILIO MD PA
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2828
Practice Address - Country:US
Practice Address - Phone:301-722-2200
Practice Address - Fax:301-722-2206
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0029467207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0096915000Medicaid
MD462171900Medicaid
MD6078Medicare ID - Type Unspecified
B41939Medicare UPIN