MEDICARE: DR. PATRICK R KENNY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	DOS-1001	HI
2	207RG0100X	Gastroenterology Physician	0102204930	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174509491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK R KENNY DO

Provider Business Mailing Address
First Line	:	121 NATIONWIDE DR
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-4272
Country	:	US
Telephone Number	:	434-384-1862
Fax Number	:	434-384-7704

Provider Business Practice Location Address
First Line	:	121 NATIONWIDE DR
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-4272
Country	:	US
Telephone Number	:	434-384-1862
Fax Number	:	434-384-7704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	07/21/2022

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