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General NPI Number Information
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NPI Number | 1649664913
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Entity Type | Individual
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Provider Name | JOSEPH MICHAEL KENNEDY M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 111 COLCHESTER AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-1473
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Country | US
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Telephone | 802-847-2434
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Fax |
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Provider Business Mailing Address
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Address Line | 75 PARK STREET
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City | ELIZABETHTOWN
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State | NY
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Zip | 12932
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Country | US
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Telephone | 518-873-6377
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036.148262
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207PT0002X
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Taxonomy Name | Medical Toxicology (Emergency Medicine) Physician
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License Number | 036.148262
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 042-0015348
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License Number State | VT
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 310427
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License Number State | NY
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