Provider Demographics
NPI:1649215971
Name:HENNESSEY, KATHRYN R (DO)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:R
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:119 SHOEMAKER RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-6429
Practice Address - Country:US
Practice Address - Phone:610-427-4919
Practice Address - Fax:610-489-6418
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007723L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10928555OtherCAQH ID#
PA4358937OtherAETNA PPO
PA0279841000OtherIBC - PC/KHPE
PA16452-OS007723LOtherHEALTH PARTNERS
PA195050OtherHIGHMARK BLUE SHIELD
PA1089445OtherCIGNA HMO/PPO
PA30019705OtherKEYSTONE MERCY
PAP00186614OtherRRM
PA0279841000OtherAMERIHEALTH/INTERCOUNTY
PA0013910420002Medicaid
PA195050OtherHIGHMARK BLUE SHIELD
PA0013910420002Medicaid