Provider Demographics
NPI:1871882795
Name:EDWARDS, KENESSA B (MD)
Entity type:Individual
Prefix:
First Name:KENESSA
Middle Name:B
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CATHARINE STREET, P.O. BOX 550
Mailing Address - Street 2:MID-HUDSON ANESTHESIOLOGISTS, PC
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602
Mailing Address - Country:US
Mailing Address - Phone:866-885-2318
Mailing Address - Fax:845-790-2675
Practice Address - Street 1:70 DUBOIS STREET
Practice Address - Street 2:ST. LUKES HOSPITAL
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-561-4400
Practice Address - Fax:585-368-3219
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273126-1207L00000X, 207LP2900X
NY273126207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04501364Medicaid
NYJ400326750-GRPBA0017Medicare PIN
NY04501364Medicaid