Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 50080 | MA |
NPI | 1053307934 |
---|---|
Provider Name | Lawrence A. Kenney |
First Address | Brighton, MA 02135 |
Second Address | Brighton, MA 02135-2907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 18/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3030601 | (05) | MA |
B74709 | (02) |