MEDICARE: KENNETH R ALLEYNE MD

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	207X00000X	Orthopaedic Surgery Physician	038984	CT

General Provider Information

NPI Number	:	1316991136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH R ALLEYNE MD

Provider Business Mailing Address
First Line	:	2800 TAMARACK RD
Second Line	:	SUITE 104
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-5539
Country	:	US
Telephone Number	:	860-648-4480
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 TAMARACK RD
Second Line	:	SUITE 104
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-5539
Country	:	US
Telephone Number	:	860-648-4480
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/02/2012

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