Healthcare Provider Details

I. General information

NPI: 1114097623
Provider Name (Legal Business Name): MARY JO KENDRICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY JO KERNS

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 COLUMBUS AVE STE 104
WASHINGTON COURT HOUSE OH
43160-3701
US

IV. Provider business mailing address

5300 FAR HILLS AVENUE
DAYTON OH
45429-2347
US

V. Phone/Fax

Practice location:
  • Phone: 614-268-2748
  • Fax:
Mailing address:
  • Phone: 937-433-7536
  • Fax: 937-433-9612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number35.090906
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: