Provider Demographics
NPI:1932137692
Name:KENNEDY, JANICE L (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 12TH FLOOR ATTN PHYSICIAN SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-368-5529
Mailing Address - Fax:508-368-5530
Practice Address - Street 1:165 MILL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3242
Practice Address - Country:US
Practice Address - Phone:978-534-6500
Practice Address - Fax:978-534-2991
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-10-28
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Provider Licenses
StateLicense IDTaxonomies
MA76277208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherPRIVATE HEALTHCARE SYSTEM
7243327OtherAETNA US HEALTHCARE
042472266OtherONE HEALTH PLAN
1060830OtherFIRST HEALTH
J13644OtherBLUE SHIELD INDEMNITY
0150199OtherCIGNA HEALTH PLAN
29229OtherHEALTHY START
784151OtherMVP HEALTH CARE
042472266OtherHEALTHCARE VALUE MANAGEME
3105598OtherMEDICAID WELFARE
J13644OtherMEDICARE B
MA3105598Medicaid
91838OtherFALLON COMMUNITY HEALTH P
AA1276OtherHARVARD PILGRIM HEALTHCAR
J13644OtherBLUE CARE ELECT
J13644OtherBLUE SHIELD HMO BLUE
042472266OtherTHREE RIVERS
29229OtherCHILDRENS MEDICAL SECURIT