Healthcare Provider Details

I. General information

NPI: 1427320043
Provider Name (Legal Business Name): JAMES R. HENNESSY, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28442 E. RIVER ROAD SUITE 203
PERRYSBURG OH
43551
US

IV. Provider business mailing address

2222 CHERRY STREET SUITE 2800
TOLEDO OH
43608
US

V. Phone/Fax

Practice location:
  • Phone: 419-350-6739
  • Fax: 419-251-3845
Mailing address:
  • Phone: 419-350-6739
  • Fax: 419-251-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35043054
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35043054
License Number StateOH

VIII. Authorized Official

Name: DR. JAMES ROBERT HENNESSY
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 419-350-6739