Healthcare Provider Details

I. General information

NPI: 1811989437
Provider Name (Legal Business Name): DAVID A KENNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 SOUTH ST
GREENSBURG PA
15601-2775
US

IV. Provider business mailing address

520 JEFFERSON AVE STE 400
JEANNETTE PA
15644-2538
US

V. Phone/Fax

Practice location:
  • Phone: 724-830-8527
  • Fax: 724-850-3145
Mailing address:
  • Phone: 724-527-8060
  • Fax: 724-522-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD018202E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD018202E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: