Provider Demographics
NPI:1740272517
Name:KERNAN, DONALD (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:KERNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-2006
Mailing Address - Country:US
Mailing Address - Phone:603-752-2040
Mailing Address - Fax:603-752-1709
Practice Address - Street 1:2 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-1502
Practice Address - Country:US
Practice Address - Phone:603-466-2741
Practice Address - Fax:603-466-2953
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6901207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0107140YPNH02OtherANTHEM BC/BS
4147522OtherMVP HEALTHCARE
NH30204170Medicaid
P00186636OtherRAILROAD MEDICARE
NH3072596Medicaid
NH6901OtherSTATE LICENSE #
NH2970924001OtherCIGNA HEALTHCARE
5830418OtherAETNA GROUP
AA28313OtherHARVARD PILGRIM
AK2693275OtherFEDERAL DEA#
5830418OtherAETNA GROUP
NH2970924001OtherCIGNA HEALTHCARE