Provider Demographics
NPI:1992791867
Name:KENNA, DENISE M (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:M
Last Name:KENNA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2350 FREEDOM WAY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402
Mailing Address - Country:US
Mailing Address - Phone:717-741-9914
Mailing Address - Fax:717-741-9917
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 107
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402
Practice Address - Country:US
Practice Address - Phone:717-741-9914
Practice Address - Fax:717-741-9917
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2015-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4181572086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001866305004Medicaid
054132Medicare PIN
PAC04290Medicare UPIN
PA001866305004Medicaid