Basic Information
| Provider Information | |||||||||
| NPI: | 1770679730 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENEALY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | FX | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683103 | ||||||||
| FaxNumber: | 5083683104 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 SUMMER ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016081216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683103 | ||||||||
| FaxNumber: | 5083683104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 174400000X | 74266 | MA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 040004967 | 01 | MA | TRAVELERS MEDICARE | OTHER | 54857 | 01 | MA | FALLON DIRECT/SELECT | OTHER | 61683 | 01 | MA | USHC | OTHER | 074266 | 01 | MA | TUFTS | OTHER | 1000006 | 01 | MA | UNITED HEALTHCARE | OTHER | 19143 | 01 | MA | HARVARD PILGRIM MWMC IPA | OTHER | 19551 | 01 | MA | HARVARD PILGRIM MILF IPA | OTHER | 3087514 | 05 | MA | MEDICAID | 0017055 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER | 23504 | 01 | MA | CHILDRENS MEDICAL SEC | OTHER | J11142 | 01 | MA | BLUE CROSS BLUE SHEILD | OTHER |