Healthcare Provider Details

I. General information

NPI: 1316092554
Provider Name (Legal Business Name): DAVID N KENAGY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTH ACADEMY AVE
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

PO BOX 191
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6440
  • Fax: 570-271-6002
Mailing address:
  • Phone: 302-651-5453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number35056456
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberC1-0012363
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD451235
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: