Healthcare Provider Details

I. General information

NPI: 1336586379
Provider Name (Legal Business Name): PAUL BERNARD MCKENNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CHESTNUT ST FIFTH FLOOR
PHILADELPHIA PA
19107-4216
US

IV. Provider business mailing address

925 CHESTNUT ST FIFTH FLOOR
PHILADELPHIA PA
19107-4216
US

V. Phone/Fax

Practice location:
  • Phone: 267-339-3500
  • Fax:
Mailing address:
  • Phone: 267-339-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD448826
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: