Provider Demographics
NPI:1104919166
Name:FERNANDES BARBOSA, KENEL (MD)
Entity type:Individual
Prefix:
First Name:KENEL
Middle Name:
Last Name:FERNANDES BARBOSA
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:BUZON 6310 SANTA ROSA STATION
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960
Mailing Address - Country:US
Mailing Address - Phone:787-269-4740
Mailing Address - Fax:787-269-4670
Practice Address - Street 1:INSTITUTO SAN PALBO OFIC 509
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-269-4670
Practice Address - Fax:787-269-4740
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7336207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0029292Medicare ID - Type Unspecified
E66463Medicare UPIN