Provider Demographics
NPI:1316566839
Name:KENNEDY, STEPHEN SMITH (MD, FACP)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SMITH
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 DOE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:GOODVIEW
Mailing Address - State:VA
Mailing Address - Zip Code:24095-2496
Mailing Address - Country:US
Mailing Address - Phone:540-890-5347
Mailing Address - Fax:
Practice Address - Street 1:1108 DOE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:GOODVIEW
Practice Address - State:VA
Practice Address - Zip Code:24095-2496
Practice Address - Country:US
Practice Address - Phone:540-890-5347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033888207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology