Healthcare Provider Details

I. General information

NPI: 1164124152
Provider Name (Legal Business Name): MADISON FRANCES KENNEDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE STE 3A-08
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

1000 BLYTHE BLVD 5TH FLOOR MEB
CHARLOTTE NC
28203-5812
US

V. Phone/Fax

Practice location:
  • Phone: 212-259-6777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026-00930
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: