Healthcare Provider Details

I. General information

NPI: 1033371299
Provider Name (Legal Business Name): TODD ALAN KERENSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FOGG ROAD
WEYMOUTH MA
02190-3003
US

IV. Provider business mailing address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

V. Phone/Fax

Practice location:
  • Phone: 781-624-8000
  • Fax: 781-878-6750
Mailing address:
  • Phone: 352-265-0239
  • Fax: 352-265-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number245493
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number245493
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number61-1403
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: