Provider Demographics
NPI:1396985370
Name:KENNEDY, MAURA (MD)
Entity type:Individual
Prefix:DR
First Name:MAURA
Middle Name:
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 1:1 DEACONESS RD
Mailing Address - Street 2:DEPARTMENT EMERGENCY MEDICINE W/CC-2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5321
Mailing Address - Country:US
Mailing Address - Phone:617-754-2339
Mailing Address - Fax:617-754-2350
Practice Address - Street 1:1 DEACONESS RD
Practice Address - Street 2:DEPARTMENT EMERGENCY MEDICINE W/CC-2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5321
Practice Address - Country:US
Practice Address - Phone:617-754-2339
Practice Address - Fax:617-754-2350
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA228079207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine