Provider Demographics
NPI:1932246170
Name:KENNEDY, MARCUS PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:PETER
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST
Mailing Address - Street 2:MAIL SLOT 555
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7199
Mailing Address - Country:US
Mailing Address - Phone:501-686-5525
Mailing Address - Fax:501-686-7893
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:MAIL SLOT 555
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7199
Practice Address - Country:US
Practice Address - Phone:501-686-5525
Practice Address - Fax:501-686-7893
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5260207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR07090022400OtherQUALCHOICE
ARP00405677OtherRAILROAD MEDICARE
AR5N843OtherBCBS
AR07090022400OtherQUALCHOICE