Basic Information
| Provider Information | |||||||||
| NPI: | 1891748554 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KENNEDY | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 54802 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701544802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047806629 | ||||||||
| FaxNumber: | 5044573132 | ||||||||
| Practice Location | |||||||||
| Address1: | 4428 HOUMA BLVD | ||||||||
| Address2: | STE 410 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044540606 | ||||||||
| FaxNumber: | 5044540705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 04/07/2009 | ||||||||
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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 | 207V00000X | MD013932 | LA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1308234 | 05 | LA | MEDICAID |