Provider Demographics
NPI:1528252335
Name:BAY AREA OBSTETRICS AND GYNECOLOGY,PA
Entity type:Organization
Organization Name:BAY AREA OBSTETRICS AND GYNECOLOGY,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PA
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-460-5205
Mailing Address - Street 1:17 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4123
Mailing Address - Country:US
Mailing Address - Phone:281-332-9511
Mailing Address - Fax:281-332-6685
Practice Address - Street 1:17 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4123
Practice Address - Country:US
Practice Address - Phone:281-332-9511
Practice Address - Fax:281-332-6685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00137YOtherGROUP MEDICARE PROVIDER N