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Individual

MICHAEL T KENNEDY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
148 FAIRFIELD ST, ST ALBANS, VT 05478-1729
(802) 524-2168
(802) 524-0411
Mailing address
PO BOX 166, ST ALBANS, VT 05478-0166
(802) 524-2168
(802) 524-0411

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0420010044
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
02V202
MVP HEALTH CARE
VT
05
0VN2288
VT
01
28637
BLUE CROSS BLUE SHIELD
VT
01
5269401
FAHC PREFERRED
VT
Enumeration date
10/24/2005
Last updated
07/08/2007
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