1093205395 NPI number — DR. CADY NOELLE KENNEDY MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093205395 NPI number — DR. CADY NOELLE KENNEDY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENNEDY
Provider First Name:
CADY
Provider Middle Name:
NOELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SITTLINGER
Provider Other First Name:
CADY
Provider Other Middle Name:
NOELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093205395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 MATTHEW STREET
Provider Second Line Business Mailing Address:
ATTN: EMERGENCY MEDICINE RESIDENCY PROGRAM
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-568-5669
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 MATTHEW STREET
Provider Second Line Business Practice Location Address:
EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-568-5669
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  57.246687 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)