Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 00019186 | AL |
NPI | 1093821993 |
---|---|
Provider Name | Maura J Kennedy |
First Address | Birmingham, AL 35202-2366 |
Second Address | Birmingham, AL 35211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 25/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093821993 | (05) | AL |
511-03712 | BCBS OF AL (01) | AL |
F78726 | (02) |