MEDICARE: DAVID STEPHEN MCKENNA 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	207VM0101X	Maternal & Fetal Medicine Physician	35065819	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000205198	OTHER		ANTHEM PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578568424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID STEPHEN MCKENNA MD

Provider Business Mailing Address
First Line	:	1 WYOMING ST
Second Line	:	BERRY BLDG, GROUND FL
City	:	DAYTON
State	:	OH
Zip	:	45409-2722
Country	:	US
Telephone Number	:	937-208-2516
Fax Number	:	937-208-6124

Provider Business Practice Location Address
First Line	:	1 WYOMING ST
Second Line	:	BERRY BLDG, GROUND FL
City	:	DAYTON
State	:	OH
Zip	:	45409-2722
Country	:	US
Telephone Number	:	937-208-2516
Fax Number	:	937-208-6124

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/22/2013

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