Provider Demographics
NPI:1245203231
Name:KENKARE, JEANNIE M (DO)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:M
Last Name:KENKARE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:
Other - Last Name:MODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 OLD ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1711
Mailing Address - Country:US
Mailing Address - Phone:203-885-0808
Mailing Address - Fax:203-885-0813
Practice Address - Street 1:31 OLD ROUTE 7
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1711
Practice Address - Country:US
Practice Address - Phone:203-885-0808
Practice Address - Fax:203-885-0813
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042010207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001420108Medicaid
CT001420108Medicaid
I22297Medicare UPIN