Healthcare Provider Details

I. General information

NPI: 1235510462
Provider Name (Legal Business Name): KENNETH MATTHEW MCKAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HARTWELL AVE STE 101
LEXINGTON MA
02421-3118
US

IV. Provider business mailing address

110 HARTWELL AVE STE 101
LEXINGTON MA
02421-3118
US

V. Phone/Fax

Practice location:
  • Phone: 781-890-1023
  • Fax:
Mailing address:
  • Phone: 781-890-1023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1014242
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: