MEDICARE: ROBERT G KENNEDY MD

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	207Q00000X	Family Medicine Physician	C161212	CA
2	207Q00000X	Family Medicine Physician	0101238231	VA
3	207QS0010X	Sports Medicine (Family Medicine) Physician	0101238231	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VVE6439975	OTHER	VA	MEDICARE PTAN-AHWI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	179367	OTHER	VA	ANTHEM
3	5630042	OTHER	VA	FIRST HEALTH
4	010160367	OTHER	VA	VA PREMIER
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	97250	OTHER	VA	OPTIMA
7	315335	OTHER	VA	SOUTHERN HEALTH

General Provider Information

NPI Number	:	1295707784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT G KENNEDY MD

Provider Business Mailing Address
First Line	:	724 S MASON ST MSC 7901
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22807-5705
Country	:	US
Telephone Number	:	540-568-5728
Fax Number	:

Provider Business Practice Location Address
First Line	:	724 S MASON ST MSC 7901
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22807-5705
Country	:	US
Telephone Number	:	540-568-5728
Fax Number	:

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	07/09/2023

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Directions to “ ROBERT G KENNEDY MD” Practice Location

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