Provider Demographics
NPI:1043487036
Name:WOLPERT, KENNETH ALAN (PA-C, CDE)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ALAN
Last Name:WOLPERT
Suffix:
Gender:M
Credentials:PA-C, CDE
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 61982
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27715-1982
Mailing Address - Country:US
Mailing Address - Phone:919-961-7394
Mailing Address - Fax:
Practice Address - Street 1:4551 NEW BERN AVE STE 160
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1552
Practice Address - Country:US
Practice Address - Phone:919-556-1008
Practice Address - Fax:919-556-6099
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC101773363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant