Healthcare Provider Details

I. General information

NPI: 1245502988
Provider Name (Legal Business Name): MARTHA OBENG KENNEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. MARTHA OBENG AMOAKO

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberD0083849
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0083849
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2018-02073
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: