Provider Demographics
NPI:1073512489
Name:ENANY, ALBERT KELLY II (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:KELLY
Last Name:ENANY
Suffix:II
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 1:208 S ARCH ST
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3519
Mailing Address - Country:US
Mailing Address - Phone:724-628-3500
Mailing Address - Fax:724-628-9009
Practice Address - Street 1:208 S ARCH ST
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3519
Practice Address - Country:US
Practice Address - Phone:724-628-3500
Practice Address - Fax:724-628-9009
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025813E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0912430Medicaid
PA428140Medicare PIN
PA0912430Medicaid