Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | C1-0011460 | DE |
N | 2080P0204X | Pediatric Emergency Doctor | 293817 | NY |
NPI | 1215295381 |
---|---|
Provider Name | Dr. Thomas Michael Kennedy |
First Address | Rockland, DE 19732-0191 |
Second Address | Wilmington, DE 19803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2012 |
Last Update Date | 22/06/2018 |