Provider Demographics
NPI:1174713218
Name:KENNEY, PATRICK A (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:KENNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:789 HOWARD AVENUE, FMP 315A
Mailing Address - Street 2:YALE UNIVERSITY, DEPT OF UROLOGY
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519
Mailing Address - Country:US
Mailing Address - Phone:203-785-2815
Mailing Address - Fax:203-785-4043
Practice Address - Street 1:789 HOWARD AVENUE, FMP 315A
Practice Address - Street 2:YALE UNIVERSITY, DEPT OF UROLOGY
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-785-2815
Practice Address - Fax:203-785-4043
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT051947208800000X
MA233892208800000X
TXN9719208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285348301 (MDACC)Medicaid
TX8CZ276OtherBCBS (MDACC)
TX285348301 (MDACC)Medicaid