Provider Demographics
NPI:1215682588
Name:KENNEALLY, LINWOOD W (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:LINWOOD
Middle Name:W
Last Name:KENNEALLY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:74 MAPLE DELL LN
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-2434
Mailing Address - Country:US
Mailing Address - Phone:617-212-4004
Mailing Address - Fax:
Practice Address - Street 1:107 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2401
Practice Address - Country:US
Practice Address - Phone:508-453-3028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPA1362363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical