Provider Demographics
NPI:1225097629
Name:KENDALL, CAROLYN J (DO)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:KENDALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 STRAW AVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1464
Mailing Address - Country:US
Mailing Address - Phone:413-584-4793
Mailing Address - Fax:413-585-0018
Practice Address - Street 1:15 STRAW AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1464
Practice Address - Country:US
Practice Address - Phone:413-584-4793
Practice Address - Fax:413-585-0018
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000007740OtherBMC
MA158845OtherTUFTS
MA27158OtherHNE
MA2500967OtherAETNA
MA158845OtherCONNECTICARE
MA69915OtherHARVARD PILGRIM
MAJ22686OtherBCBSMA
MA0121801Medicaid
MA102748OtherCIGNA
MA27158OtherHNE
H19444Medicare UPIN