MEDICARE: STUART A KENDALL 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	207R00000X	Internal Medicine Physician	41098	MA

General Provider Information

NPI Number	:	1467418426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STUART A KENDALL MD

Provider Business Mailing Address
First Line	:	PO BOX 1477
Second Line	:	ONE HOSPITAL ROAD
City	:	OAK BLUFFS
State	:	MA
Zip	:	02557-1477
Country	:	US
Telephone Number	:	508-693-0410
Fax Number	:	508-693-5971

Provider Business Practice Location Address
First Line	:	ONE HOSPITAL ROAD
Second Line	:
City	:	OAK BLUFFS
State	:	MA
Zip	:	02557-1477
Country	:	US
Telephone Number	:	508-693-0410
Fax Number	:	508-693-5971

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	10/29/2014

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