Provider Demographics
NPI:1902097512
Name:TOMCZYK, KENNETH HUGH (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HUGH
Last Name:TOMCZYK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-5097
Mailing Address - Country:US
Mailing Address - Phone:843-547-4765
Mailing Address - Fax:843-547-4766
Practice Address - Street 1:50 TERRACE DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-5097
Practice Address - Country:US
Practice Address - Phone:843-547-4765
Practice Address - Fax:843-547-4766
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013802207Q00000X
SC93632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102173336Medicaid
PA127239Medicare PIN