Basic Information
| Provider Information | |||||||||
| NPI: | 1922593136 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KENNY | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 FRANCIS ST | ||||||||
| Address2: | DEPARTMENT OF RADIOLOGY | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177326304 | ||||||||
| FaxNumber: | 6177326317 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 FRANCIS ST | ||||||||
| Address2: | DEPARTMENT OF RADIOLOGY | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177326304 | ||||||||
| FaxNumber: | 6177326317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2018 | ||||||||
| LastUpdateDate: | 02/25/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 02/13/2019 | ||||||||
| NPIReactivationDate: | 02/25/2019 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.