Provider Demographics
NPI:1023007358
Name:KENNY, BRIAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
Last Name:KENNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2153 DEPT 40338
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-9386
Mailing Address - Country:US
Mailing Address - Phone:423-310-1642
Mailing Address - Fax:
Practice Address - Street 1:546 SOUTH ST E
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1079
Practice Address - Country:US
Practice Address - Phone:508-821-5700
Practice Address - Fax:617-479-0857
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA82051207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3147711Medicaid
MA3147711Medicaid
MAG19308Medicare UPIN