Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 35-090631 | OH |
NPI | 1801004585 |
---|---|
Provider Name | Daniel William Kennedy |
First Address | Newark, OH 43058-0948 |
Second Address | Newark, OH 43055-1822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 13/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3039198 | (05) | OH |
P00880289 | RAILROAD MEDICARE (01) | OH |