Provider Demographics
NPI:1558340372
Name:KENNY, PETER C (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:C
Last Name:KENNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 LOCUST ST
Mailing Address - Street 2:#2
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2066
Mailing Address - Country:US
Mailing Address - Phone:413-584-8700
Mailing Address - Fax:413-584-1714
Practice Address - Street 1:193 LOCUST ST
Practice Address - Street 2:#2
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2066
Practice Address - Country:US
Practice Address - Phone:413-584-8700
Practice Address - Fax:413-584-1714
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA39657208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4235652OtherAETNA
MA000000008099OtherBMC
MA13563OtherHEALTH NEW ENGLAND
MA039657OtherTUFTS
MA200186OtherHARVARD PILGRIM
MA2052563Medicaid
MA10242202OtherCIGNA
MA747581OtherCONNECTICARE
MAG14108OtherBCBS MA
MA039657OtherTUFTS