Healthcare Provider Details

I. General information

NPI: 1619979200
Provider Name (Legal Business Name): ALEXA C KEMENY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 SHERMAN DR STE 1
ST JOHNSBURY VT
05819-9280
US

IV. Provider business mailing address

PO BOX 905
ST JOHNSBURY VT
05819-0905
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-5131
  • Fax: 802-748-4237
Mailing address:
  • Phone: 802-748-8141
  • Fax: 802-748-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA72550
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042.0018206
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: