Provider Demographics
NPI:1871561597
Name:KENNEDY, NAHID B (DO)
Entity type:Individual
Prefix:DR
First Name:NAHID
Middle Name:B
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2302
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-8301
Mailing Address - Country:US
Mailing Address - Phone:781-871-5030
Mailing Address - Fax:781-871-5480
Practice Address - Street 1:135 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1200
Practice Address - Country:US
Practice Address - Phone:781-871-5030
Practice Address - Fax:781-871-5480
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3142540Medicaid
MA3142540Medicaid
MAA20056Medicare PIN