MEDICARE: DR. BRIAN A. KENNY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	82051	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023007358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN A. KENNY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2153 DEPT 40338
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35287-9386
Country	:	US
Telephone Number	:	423-310-1642
Fax Number	:

Provider Business Practice Location Address
First Line	:	546 SOUTH ST E
Second Line	:
City	:	RAYNHAM
State	:	MA
Zip	:	02767-1079
Country	:	US
Telephone Number	:	508-821-5700
Fax Number	:	617-479-0857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	01/16/2023

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