Provider Demographics
NPI:1962565382
Name:KENERSON, ROBERT FOSTER (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FOSTER
Last Name:KENERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:25 BAY STATE RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-353-0120
Mailing Address - Fax:617-425-0525
Practice Address - Street 1:25 BAY STATE RD
Practice Address - Street 2:SUITE #1
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-353-0120
Practice Address - Fax:617-425-0525
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA306762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A33237Medicare UPIN
MAVO2118Medicare ID - Type Unspecified
MAB11379Medicare ID - Type Unspecified