1497780548 NPI number — CHRISTOPHER M KENNEY M.D.

Table of content: CHRISTOPHER M KENNEY M.D. (NPI 1497780548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497780548 NPI number — CHRISTOPHER M KENNEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENNEY
Provider First Name:
CHRISTOPHER
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497780548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1085 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH WEYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02190-1547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-331-2922
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 LONGWATER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02061-1683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-878-5200
Provider Business Practice Location Address Fax Number:
781-878-6750
Provider Enumeration Date:
07/11/2006

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: 207RG0100X , with the licence number:  217836 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 042297845 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 217836 . This is a "TUFTS AND TMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7766145 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "MUTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110034628A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA174499 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: SS0068 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6036494 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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