Provider Demographics
NPI:1366555732
Name:MCKENNEY, BRAD A (MD)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:A
Last Name:MCKENNEY
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 1:1066 CHELMSFORD ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-6023
Mailing Address - Country:US
Mailing Address - Phone:330-966-4563
Mailing Address - Fax:
Practice Address - Street 1:1320 MERCY DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2614
Practice Address - Country:US
Practice Address - Phone:330-492-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052403207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0657294Medicaid
OH0596487Medicare PIN
OH0657294Medicaid
OHMC0596486Medicare PIN
OH0596489Medicare PIN
OH4310061Medicare PIN
OHMC0596484Medicare ID - Type Unspecified