Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 27418 | NE |
N | 208000000X | Pediatrician | A118536 | CA |
N | 2080P0204X | Pediatric Emergency Doctor | 04-39698 | KS |
Y | 2080P0204X | Pediatric Emergency Doctor | 30226 | WV |
N | 2080P0204X | Pediatric Emergency Doctor | 30469 | OK |
NPI | 1235413030 |
---|---|
Provider Name | Dr. Isaac J Kennedy |
First Address | Morgantown, WV 26506 |
Second Address | Morgantown, WV 26506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2011 |
Last Update Date | 20/07/2021 |