Provider Demographics
NPI:1922593136
Name:KENNY, STEPHANIE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANNE
Last Name:KENNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-732-6304
Mailing Address - Fax:617-732-6317
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-6304
Practice Address - Fax:617-732-6317
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2019-02-25
Deactivation Date:2019-02-13
Deactivation Code:
Reactivation Date:2019-02-25
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program