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General NPI Number Information
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NPI Number | 1114904554
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Entity Type | Individual
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Provider Name | JAMES M MCKENNA MD
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Gender | Male
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 03/31/2015
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Provider Practice Location Address
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Address Line | 789 CENTRAL AVE WENTWORTH DOUGLASS HOSPITAL
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City | DOVER
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State | NH
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Zip | 03820
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Country | US
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Telephone | 603-749-7246
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Fax | 603-749-2453
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Provider Business Mailing Address
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Address Line | 3998 FAIR RIDGE DR SUITE # 300
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City | FAIRFAX
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State | VA
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Zip | 22030-2921
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Country | US
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Telephone | 603-749-7246
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Fax | 603-749-2453
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 7230
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License Number State | NH
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