Healthcare Provider Details

I. General information

NPI: 1750458071
Provider Name (Legal Business Name): RONALD C KENNEDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 NORTHPORT AVE
BELFAST ME
04915-6009
US

IV. Provider business mailing address

118 NORTHPORT AVE P.O. BOX 287
BELFAST ME
04915-6009
US

V. Phone/Fax

Practice location:
  • Phone: 207-338-2500
  • Fax: 207-338-9380
Mailing address:
  • Phone: 207-338-2500
  • Fax: 207-338-9380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number016176
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: