Provider Demographics
NPI:1811918394
Name:MCKENDALL, GEORGE R (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:MCKENDALL
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 1:2 DUDLEY ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3236
Mailing Address - Country:US
Mailing Address - Phone:404-444-5891
Mailing Address - Fax:401-444-8158
Practice Address - Street 1:2 DUDLEY ST
Practice Address - Street 2:SUITE 360
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3236
Practice Address - Country:US
Practice Address - Phone:404-444-5891
Practice Address - Fax:401-444-8158
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07812207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9006566Medicaid
RI9006566Medicaid
RI007056751Medicare ID - Type Unspecified