Healthcare Provider Details

I. General information

NPI: 1023645587
Provider Name (Legal Business Name): JOHN WILLIAM KENNEDY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BIRNIE AVE STE 201
SPRINGFIELD MA
01107-1121
US

IV. Provider business mailing address

300 BIRNIE AVE STE 201
SPRINGFIELD MA
01107-1121
US

V. Phone/Fax

Practice location:
  • Phone: 413-785-4666
  • Fax: 413-846-4756
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number31144801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: