Provider Demographics
NPI:1013076678
Name:KENNEY, ROBERT LUTHER (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LUTHER
Last Name:KENNEY
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 1:450 UPPER MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:207-859-9987
Mailing Address - Fax:
Practice Address - Street 1:325B KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4517
Practice Address - Country:US
Practice Address - Phone:207-872-6584
Practice Address - Fax:207-872-6584
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1052207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001856OtherBLUE CROSS BLUE SHIELD
ME015322Medicare ID - Type Unspecified
ME001856OtherBLUE CROSS BLUE SHIELD