Provider Demographics
NPI:1871528869
Name:KENNY, ERIC R (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:R
Last Name:KENNY
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 1:2405 ATHERHOLT RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2184
Mailing Address - Country:US
Mailing Address - Phone:434-485-8500
Mailing Address - Fax:434-485-8599
Practice Address - Street 1:2405 ATHERHOLT RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2184
Practice Address - Country:US
Practice Address - Phone:434-485-8500
Practice Address - Fax:434-485-8599
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040186207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010228590Medicaid
VA1871528869Medicaid
VA010228590Medicaid
VVJ420AMedicare PIN
VA1871528869Medicaid
P01584713Medicare PIN
VA009643T88Medicare PIN