Individual
DR. EUGENE P. KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 WALNUT ST, MOB, 5TH FLOOR, PHILADELPHIA, PA 19107-5563
(215) 955-6750
(215) 923-8222
Mailing address
615 CHESTNUT ST, 14TH FLOOR, CENTRAL ENROLLMENT, PHILADELPHIA, PA 19106-4404
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD428122
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0093815
—
NJ
05
—
101509252
—
PA
Enumeration date
07/20/2006
Last updated
05/31/2011
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