Provider Demographics
NPI:1477644367
Name:KENNEY, CHRISTOPHER JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:KENNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TECHNOLOGY PL
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-1071
Mailing Address - Country:US
Mailing Address - Phone:781-681-2439
Mailing Address - Fax:781-681-2901
Practice Address - Street 1:1 TECHNOLOGY PL
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-1071
Practice Address - Country:US
Practice Address - Phone:781-681-2439
Practice Address - Fax:781-681-2901
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2354112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178809301Medicaid
TX178809302Medicaid
8G2820Medicare PIN
8G3538Medicare PIN
H55355Medicare UPIN