Provider Demographics
NPI:1093821993
Name:KENNEDY, MAURA J (MD)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:J
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12366
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-2366
Mailing Address - Country:US
Mailing Address - Phone:205-780-7101
Mailing Address - Fax:205-206-8338
Practice Address - Street 1:12 OFFICE PARK CIR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2521
Practice Address - Country:US
Practice Address - Phone:205-933-0320
Practice Address - Fax:205-933-6400
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00019186207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1093821993Medicaid
AL511-03712OtherBCBS OF AL
AL1093821993Medicaid
AL511-03712OtherBCBS OF AL