Provider Demographics
NPI:1497780548
Name:KENNEY, CHRISTOPHER M (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
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 1:1085 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1547
Mailing Address - Country:US
Mailing Address - Phone:781-331-2922
Mailing Address - Fax:
Practice Address - Street 1:143 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1683
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:781-878-6750
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217836207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
042297845OtherCOVENTRY
217836OtherTUFTS AND TMP
7766145OtherAETNA
042297845OtherMUTIPLAN
MA110034628AMedicaid
MAAA174499OtherHARVARD PILGRIM
MASS0068OtherBCBSMA
042297845OtherUNITED HEALTH CARE
6036494OtherCIGNA
042297845OtherUNITED HEALTH CARE