1619979200 NPI number — DR. ALEXA C KEMENY MD

Table of content: DR. ALEXA C KEMENY MD (NPI 1619979200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619979200 NPI number — DR. ALEXA C KEMENY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEMENY
Provider First Name:
ALEXA
Provider Middle Name:
C
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:
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:
1619979200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 905
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST JOHNSBURY
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05819-0905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-748-8141
Provider Business Mailing Address Fax Number:
802-748-4098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
97 SHERMAN DR STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST JOHNSBURY
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05819-9280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-748-5131
Provider Business Practice Location Address Fax Number:
802-748-4237
Provider Enumeration Date:
08/12/2005

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: 208000000X , with the licence number:  MA72550 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3147643 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6718657 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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