MEDICARE: KATHARYN E. 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	207P00000X	Emergency Medicine Physician	150663	MA

General Provider Information

NPI Number	:	1487638326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHARYN E. KENNEDY MD

Provider Business Mailing Address
First Line	:	67 N QUINSIGAMOND AVE
Second Line	:	UNIT 15
City	:	SHREWSBURY
State	:	MA
Zip	:	01545-5133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 UNION ST
Second Line	:	DEPARTMENT OF EMERGENCY MEDICINE
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-1228
Country	:	US
Telephone Number	:	508-421-1400
Fax Number	:	508-421-1490

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	01/02/2020

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