Provider Demographics
NPI:1316092554
Name:KENAGY, DAVID N (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:N
Last Name:KENAGY
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:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-5453
Mailing Address - Fax:
Practice Address - Street 1:100 NORTH ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:570-271-6440
Practice Address - Fax:570-271-6002
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350564562080P0210X
DEC1-00123632080P0210X, 2080P0210X
PAMD4512352080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH737885OtherBUCKEYE
OH000000546695OtherANTHEM
OH422455OtherWELLCARE
OH0709273Medicaid
OH000000229450OtherUNISON
PA1021092000001OtherPA MEDICAID
OH4112125OtherAETNA
OH737885OtherBUCKEYE
OH0709273Medicaid
OH422455OtherWELLCARE
KY7100205990Medicaid
OH422455OtherWELLCARE