Provider Demographics
NPI:1164466249
Name:KENNEDY, HAROLD L (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:L
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:75 PRINGLE WAY
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1464
Mailing Address - Country:US
Mailing Address - Phone:775-323-7500
Mailing Address - Fax:775-789-9208
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:SUITE 1002
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-323-7500
Practice Address - Fax:775-789-9208
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV8350208C00000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016695Medicaid
NVV37198Medicare UPIN
NV2016695Medicaid