Healthcare Provider Details

I. General information

NPI: 1922385046
Provider Name (Legal Business Name): GERARD T KENNEALEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 COPLEY DR SUITE 100
WILMINGTON DE
19803-4118
US

IV. Provider business mailing address

1308 COPLEY DR SUITE 100
WILMINGTON DE
19803-4118
US

V. Phone/Fax

Practice location:
  • Phone: 302-753-9225
  • Fax:
Mailing address:
  • Phone: 302-753-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberC1-0002906
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: