Provider Demographics
NPI:1942225313
Name:KENNEDY, RICHARD THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:THOMAS
Last Name:KENNEDY
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 1:1803 BETHLEHEM RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36350-6013
Mailing Address - Country:US
Mailing Address - Phone:334-983-1864
Mailing Address - Fax:
Practice Address - Street 1:169 NORTH SECOND AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:AL
Practice Address - Zip Code:36344
Practice Address - Country:US
Practice Address - Phone:334-588-2084
Practice Address - Fax:334-588-2168
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00008459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-26056OtherBLUE CROSS / BLUE SHIELD
ALP00179451OtherMEDICARE RAILROAD
AL515-26056OtherBLUE CROSS / BLUE SHIELD