Healthcare Provider Details

I. General information

NPI: 1801004585
Provider Name (Legal Business Name): DANIEL WILLIAM KENNEDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W MAIN ST
NEWARK OH
43055-1822
US

IV. Provider business mailing address

PO BOX 948 2112 CHERRY VALLEY RD.
NEWARK OH
43058-0948
US

V. Phone/Fax

Practice location:
  • Phone: 740-348-4710
  • Fax: 740-348-4740
Mailing address:
  • Phone: 740-522-3774
  • Fax: 740-522-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number57012390
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number35-090631
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number35-090631
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number35-090631
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code2085H0002X
TaxonomyHospice and Palliative Medicine (Radiology) Physician
License Number35-090631
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number35-090631
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number35-090631
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35-090631
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number35-090631
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number35-090631
License Number StateOH
# 11
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number35-090631
License Number StateOH
# 12
Primary TaxonomyN
Taxonomy Code207UN0903X
TaxonomyIn Vivo & In Vitro Nuclear Medicine Physician
License Number35-090631
License Number StateOH
# 13
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number35-090631
License Number StateOH
# 14
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number35-090631
License Number StateOH
# 15
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.090631
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: