Provider Demographics
NPI:1114904554
Name:MCKENNA, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:MCKENNA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3998 FAIR RIDGE DR
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2921
Mailing Address - Country:US
Mailing Address - Phone:603-749-7246
Mailing Address - Fax:603-749-2453
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:WENTWORTH DOUGLASS HOSPITAL
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:603-749-7246
Practice Address - Fax:603-749-2453
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2015-03-31
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Provider Licenses
StateLicense IDTaxonomies
NH7230207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30001205Medicaid
NHNH9988Medicare PIN
E14785Medicare UPIN