Individual
KEVIN PATRICK FENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
NIH NHLBI CARDIOVASCULAR BR, 10 CENTER DRIVE, BLDG 10, ROOM 6-3152, BETHESDA, MD 20892-0001
(301) 827-0511
(301) 451-7093
Mailing address
NIH NHLBI CARDIOVASCULAR BR, 10 CENTER DRIVE, BLDG 10, ROOM 6-3152, BETHESDA, MD 20892-0001
(301) 827-0511
(301) 451-7093
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
25MA07311800
NJ
207RP1001X
Pulmonary Disease Physician
Primary
ME106064
FL
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
25MA07311800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001760100
—
FL
05
—
5650607
—
NJ
Enumeration date
07/22/2006
Last updated
12/16/2015
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