Provider Demographics
NPI:1114970357
Name:KENNEDY, JAMES P (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:KENNEDY
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 1:72 5TH ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4201
Mailing Address - Country:US
Mailing Address - Phone:330-670-4111
Mailing Address - Fax:330-670-4113
Practice Address - Street 1:72 5TH ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4201
Practice Address - Country:US
Practice Address - Phone:330-670-4111
Practice Address - Fax:330-670-4113
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.052187207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0803090Medicaid
OH0803090Medicaid
OH0674914Medicare PIN