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NPI Code Detail

MEDICARE: DENISE R KENNEDY MD

MEDICARE: DENISE R 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
1207Q00000XFamily Medicine PhysicianME122127FL
2207Q00000XFamily Medicine Physician35.084408OH

Other Identifiers

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

General Provider Information

NPI Number : 1326066713
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENISE R KENNEDY MD
Provider Business Mailing Address
First Line : 4790 COTTONVILLE RD
Second Line :
City : JAMESTOWN
State : OH
Zip : 45335-1518
Country : US
Telephone Number : 937-675-2870
Fax Number : 937-675-2873
Provider Business Practice Location Address
First Line : 4790 COTTONVILLE RD
Second Line :
City : JAMESTOWN
State : OH
Zip : 45335-1518
Country : US
Telephone Number : 937-675-2870
Fax Number : 937-675-2873
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 01/20/2021

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