Healthcare Provider Details

I. General information

NPI: 1619355534
Provider Name (Legal Business Name): LUCY BOYCE KENNEDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVENUE MAIL CODE CA6-165
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVENUE, MAIL CODE CA6-165
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 615-979-1503
  • Fax:
Mailing address:
  • Phone: 216-445-6390
  • Fax: 216-444-9464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number35.142461
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: