Individual
PATRICIA RAE KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6 MEDICAL DRIVE, SUITE 202, MALTA, NY 12020
(518) 580-2170
(518) 580-2171
Mailing address
PO BOX 1368, ALBANY, NY 12201-1368
(518) 580-2170
(518) 580-2171
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
176536
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000386171
ANTHEM PIN
IN
05
—
02623274
—
NY
05
—
200800120
—
IN
Enumeration date
05/03/2006
Last updated
03/01/2016
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