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Individual

JOHN M MCKENNA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
425 NORTH LAKE AVE, WORCESTER, MA 01605
(508) 595-2513
(508) 854-0822
Mailing address
630 PLANTATION ST, WOT 12TH FL ATTN PHYSICIAN SERVICES, WORCESTER, MA 01605
(508) 368-5529
(508) 368-5530

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
37188
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0400980
EVERCARE
01
3100448
MEDICAID WELFARE
05
3100448
MA
01
3548152
CIGNA HEALTH PLAN
01
917962
FIRST HEALTH
01
9410342002
CIGNA HEALTH PLAN
01
E09004
BLUE CROSS
01
W10105401
CIGNA HEALTH PLAN
Enumeration date
09/08/2006
Last updated
07/08/2007
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