Provider Demographics
NPI:1740252402
Name:SBAT, KENNEDY J (DO)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:J
Last Name:SBAT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1569 MEDICAL DR STE 203
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3223
Mailing Address - Country:US
Mailing Address - Phone:484-624-4719
Mailing Address - Fax:484-752-4071
Practice Address - Street 1:1569 MEDICAL DR STE 203
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3223
Practice Address - Country:US
Practice Address - Phone:484-624-4719
Practice Address - Fax:484-752-4071
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006542L207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F30816Medicare UPIN
538240Medicare ID - Type Unspecified
290008685Medicare PIN