Provider Demographics
NPI:1114976214
Name:KENNEDY, GLORIA ALBARELLI (MD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:ALBARELLI
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:CENTER FOR CHILDREN'S CANCER AND BLOOD DISORDERS
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2306
Mailing Address - Country:US
Mailing Address - Phone:315-464-5294
Mailing Address - Fax:315-464-7238
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:CENTER FOR CHILDREN'S CANCER AND BLOOD DISORDERS
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-5294
Practice Address - Fax:315-464-7238
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1904401208000000X, 2080P0207X
NY190440207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01603401Medicaid
NY01603401Medicaid