MEDICARE: KENNEDY ROBINSON

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	363A00000X	Physician Assistant	7930	MA

General Provider Information

NPI Number	:	1427679596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNEDY ROBINSON

Provider Business Mailing Address
First Line	:	100 HIGHLAND ST STE 226
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-3880
Country	:	US
Telephone Number	:	617-696-1826
Fax Number	:	617-696-7380

Provider Business Practice Location Address
First Line	:	100 HIGHLAND ST STE 226
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-3880
Country	:	US
Telephone Number	:	617-696-1826
Fax Number	:

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

Provider Enumeration Date	:	04/30/2020
Last Update Date	:	06/15/2021

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Directions to “ KENNEDY ROBINSON ” Practice Location

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