Provider Demographics
NPI:1689646366
Name:KENNA, MARGARET A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:A
Last Name:KENNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:LO-367
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6417
Mailing Address - Fax:617-730-0611
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:LO-367
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6417
Practice Address - Fax:617-730-0611
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA80499207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3133729Medicaid
J3104301Medicare PIN
MA3133729Medicaid
J31043Medicare ID - Type Unspecified