Provider Demographics
NPI:1457401077
Name:KENNEDY, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:KENNEDY
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 1:705 COFFREN PLACE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:301-351-2199
Mailing Address - Fax:202-522-1746
Practice Address - Street 1:1818 H ST NW
Practice Address - Street 2:MC C2 208
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20433-0001
Practice Address - Country:US
Practice Address - Phone:202-458-0828
Practice Address - Fax:202-522-1746
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC20957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine