Provider Demographics
NPI:1669049995
Name:KD MEDICINE & WELLNESS PLLC
Entity type:Organization
Organization Name:KD MEDICINE & WELLNESS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOVIDIO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C,MHP
Authorized Official - Phone:508-641-0235
Mailing Address - Street 1:565 TURNPIKE ST STE 71
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5936
Mailing Address - Country:US
Mailing Address - Phone:508-641-0235
Mailing Address - Fax:
Practice Address - Street 1:565 TURNPIKE ST STE 71
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5936
Practice Address - Country:US
Practice Address - Phone:508-641-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty