Provider Demographics
NPI:1750387544
Name:KENNEY, JOSEPH S III (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:KENNEY
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 BALA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3207
Mailing Address - Country:US
Mailing Address - Phone:610-660-9910
Mailing Address - Fax:610-660-9920
Practice Address - Street 1:1 BALA AVE STE 300
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3207
Practice Address - Country:US
Practice Address - Phone:610-660-9910
Practice Address - Fax:610-660-9920
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-26
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006801E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011719890003Medicaid
PAE52837Medicare UPIN
PAKE469257Medicare ID - Type Unspecified