Provider Demographics
NPI:1134177546
Name:JANES, KENNETH A (MD)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:A
Last Name:JANES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:190 GROTON ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432
Mailing Address - Country:US
Mailing Address - Phone:978-772-6265
Mailing Address - Fax:978-772-5348
Practice Address - Street 1:190 GROTON ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432
Practice Address - Country:US
Practice Address - Phone:978-772-6265
Practice Address - Fax:978-772-5348
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31891208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2031132Medicaid
MAB1817002OtherPTAN 41
708834OtherTUFTS
801509OtherHARVARD PILGRIM
MAB1817001OtherPTAN
B87059Medicare UPIN
MA2031132Medicaid