Provider Demographics
NPI:1578504635
Name:KENNEDY, ALASTAIR CATHCART (MD)
Entity Type:Individual
Prefix:
First Name:ALASTAIR
Middle Name:CATHCART
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 1:1300 36TH STREET
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960
Mailing Address - Country:US
Mailing Address - Phone:772-569-8550
Mailing Address - Fax:772-567-4345
Practice Address - Street 1:1300 36TH STREET
Practice Address - Street 2:SUITE 1A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-569-8550
Practice Address - Fax:772-567-4345
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0035846207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039586200Medicaid
FL31121ZMedicare PIN
FL039586200Medicaid