Provider Demographics
NPI:1104851872
Name:MCKENNA, PATRICK JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JAMES
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 241359
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-5359
Mailing Address - Country:US
Mailing Address - Phone:402-398-5994
Mailing Address - Fax:402-398-5978
Practice Address - Street 1:7500 MERCY RD
Practice Address - Street 2:ALEGENT HEALTH BERGAN MERCY RADIATION ONCOLOGY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2319
Practice Address - Country:US
Practice Address - Phone:402-398-6485
Practice Address - Fax:402-398-6621
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE121812085R0203X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Not Answered2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEDO9058Medicare UPIN