Provider Demographics
NPI:1720201528
Name:DR ALASTAIR C KENNEDY MD MRCP FACP PA
Entity Type:Organization
Organization Name:DR ALASTAIR C KENNEDY MD MRCP FACP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALASTAIR
Authorized Official - Middle Name:CATHCART
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:772-569-8550
Mailing Address - Street 1:1300 36TH ST
Mailing Address - Street 2:SUITE 1 A
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4898
Mailing Address - Country:US
Mailing Address - Phone:772-569-8550
Mailing Address - Fax:772-567-4345
Practice Address - Street 1:1300 36TH ST
Practice Address - Street 2:SUITE 1 A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4898
Practice Address - Country:US
Practice Address - Phone:772-569-8550
Practice Address - Fax:772-567-4345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039586200Medicaid
FLK1755Medicare PIN
FL039586200Medicaid