Provider Demographics
NPI:1891748554
Name:KENNEDY, THOMAS JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54802
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4802
Mailing Address - Country:US
Mailing Address - Phone:504-780-6629
Mailing Address - Fax:504-457-3132
Practice Address - Street 1:4428 HOUMA BLVD
Practice Address - Street 2:STE 410
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-454-0606
Practice Address - Fax:504-454-0705
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD013932207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1308234Medicaid
LA5DH66Medicare PIN
LA52768Medicare ID - Type Unspecified
LA1308234Medicaid
LAB64116Medicare UPIN