Provider Demographics
NPI:1942240973
Name:KENNEALY, JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:KENNEALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3397
Mailing Address - Country:US
Mailing Address - Phone:513-853-4721
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:2001 ANDERSON FERRY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3325
Practice Address - Country:US
Practice Address - Phone:513-246-7000
Practice Address - Fax:513-922-2103
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033588207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH386434Medicaid
OHP00340571OtherMEDICARE RR
OHKE0430846Medicare PIN
OH0430845Medicare PIN
OHA75781Medicare UPIN