Provider Demographics
NPI:1285620948
Name:KENYON, KENNETH RALPH (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RALPH
Last Name:KENYON
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 1:51 STATE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3319
Mailing Address - Country:US
Mailing Address - Phone:508-994-1400
Mailing Address - Fax:508-910-2212
Practice Address - Street 1:51 STATE RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3319
Practice Address - Country:US
Practice Address - Phone:508-993-3023
Practice Address - Fax:508-993-3162
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39409207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM09185OtherB/C B/S OF MASS
MA2042886Medicaid
RI7009538Medicaid
MAM09185Medicare PIN
MA180013281Medicare PIN
RI7009538Medicaid
MA2042886Medicaid
MADX3542Medicare PIN