Provider Demographics
NPI:1316994601
Name:KENNEDY-LITTLE, DAWN MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:MARIE
Last Name:KENNEDY-LITTLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:331 NEWMAN SPRINGS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5792
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07337300207R00000X, 207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0124281Medicaid
NJ43878OtherUNIVERSITY HEALTH PLAN
NJ176664OtherMEDICARE PTAN
NJ2K6834OtherHEALTHNET
NJ60031112OtherHORIZON NJ HEALTH
NJP3737076OtherOXFORD
NJ010078063OtherAMERICHOICE
NJ2005562OtherUNITED HEALTHCARE
NJ3K6136OtherHEALTHNET, INC
NJ9518755OtherCIGNA
NJ2310513000OtherAMERIHEALTH/KEYSTONE/IBC
NJ1448501OtherAETNA
NJP00391554OtherRR MEDICARE
NJ078114Medicare PIN
NJ2K6834OtherHEALTHNET
NJ010078063OtherAMERICHOICE