Healthcare Provider Details

I. General information

NPI: 1780644328
Provider Name (Legal Business Name): GEORGE W KENNEDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 W PITTSBURGH ST
GREENSBURG PA
15601-2239
US

IV. Provider business mailing address

501 W OTTERMAN ST SUITE B
GREENSBURG PA
15601-2126
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-4626
  • Fax: 724-832-4668
Mailing address:
  • Phone: 724-850-6933
  • Fax: 724-836-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD050604L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: