Provider Demographics
NPI:1427126812
Name:KENNANE, THOMAS P (PHYSCIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:P
Last Name:KENNANE
Suffix:
Gender:M
Credentials:PHYSCIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SAINT GEORGE BLVD APT 10I
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9351
Mailing Address - Country:US
Mailing Address - Phone:412-519-7339
Mailing Address - Fax:
Practice Address - Street 1:101 SAINT GEORGE BLVD APT 10I
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-9351
Practice Address - Country:US
Practice Address - Phone:412-519-7339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001602-L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA001602-LOtherPA LICENSE