Provider Demographics
NPI:1578527230
Name:KENYON, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:KENYON
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:41 HIGHLAND AVE
Mailing Address - Street 2:WINCHESTER HOSPITAL INPATIENT SPECIALIST OFFICE
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1446
Mailing Address - Country:US
Mailing Address - Phone:781-756-7095
Mailing Address - Fax:781-756-7090
Practice Address - Street 1:41 HIGHLAND AVE
Practice Address - Street 2:WINCHESTER HOSPITAL INPATIENT SPECIALIST OFFICE
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1446
Practice Address - Country:US
Practice Address - Phone:781-756-7095
Practice Address - Fax:781-756-7090
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA154840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3181171Medicaid
MA3181171Medicaid
MAG55306Medicare UPIN