Provider Demographics
NPI:1518258755
Name:KENNEDY, DAVID PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PATRICK
Last Name:KENNEDY
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 1:4224 HOUMA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2934
Mailing Address - Country:US
Mailing Address - Phone:504-454-1000
Mailing Address - Fax:504-456-8010
Practice Address - Street 1:4224 HOUMA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2934
Practice Address - Country:US
Practice Address - Phone:504-454-1000
Practice Address - Fax:504-456-8010
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9617207W00000X
TXBP20041200390200000X
LA207639207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program