Healthcare Provider Details

I. General information

NPI: 1306836515
Provider Name (Legal Business Name): AMY ELIZABETH ROBERTS KENNEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ELIZABETH ROBERTS KENNEY M.D.

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE DEPARTMENT OF CARDIOLOGY
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-8794
  • Fax: 617-739-6282
Mailing address:
  • Phone: 617-724-0287
  • Fax: 617-726-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number210187
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number210187
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: