Basic Information
| Provider Information | |||||||||
| NPI: | 1558340372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENNY | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 193 LOCUST ST | ||||||||
| Address2: | #2 | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135848700 | ||||||||
| FaxNumber: | 4135841714 | ||||||||
| Practice Location | |||||||||
| Address1: | 193 LOCUST ST | ||||||||
| Address2: | #2 | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135848700 | ||||||||
| FaxNumber: | 4135841714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 39657 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 4235652 | 01 | MA | AETNA | OTHER | 000000008099 | 01 | MA | BMC | OTHER | 13563 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 039657 | 01 | MA | TUFTS | OTHER | 200186 | 01 | MA | HARVARD PILGRIM | OTHER | 2052563 | 05 | MA | MEDICAID | 10242202 | 01 | MA | CIGNA | OTHER | 747581 | 01 | MA | CONNECTICARE | OTHER | G14108 | 01 | MA | BCBS MA | OTHER |