Provider Demographics
NPI:1326096793
Name:KEARNEY, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:KEARNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:110 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-5919
Mailing Address - Country:US
Mailing Address - Phone:518-762-2020
Mailing Address - Fax:518-736-1200
Practice Address - Street 1:110 N PINE ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-5919
Practice Address - Country:US
Practice Address - Phone:518-762-2020
Practice Address - Fax:518-736-1200
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116539-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00462166Medicaid
0826320001Medicare NSC
NY38641BMedicare ID - Type Unspecified
NYB82117Medicare UPIN