Individual
SUSAN LUCILLE KENNEDY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3949 BROWNING PL, RALEIGH, NC 27609-6504
(919) 787-8221
(919) 789-4461
Mailing address
PO BOX 19368, RALEIGH, NC 27619-9368
(919) 787-8221
(919) 789-4461
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
96-0291
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16-54610
UNITED HEALTHCARE
NC
01
—
16-54611
UNITED HEALTHCARE
NC
01
—
16-54612
UNITED HEALTHCARE
NC
01
—
48598
BLUECROSS BLUESHIELD
NC
01
—
64580
MEDCOST
NC
01
—
64587
MEDCOST
NC
01
—
64590
MEDCOST
NC
01
—
7228732
VIRGINIA MEDICAID
VA
05
—
8948598
—
NC
Enumeration date
06/06/2006
Last updated
07/08/2007
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