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Contact Information

THOMAS J KENNEDY III, MD
527 MEDICAL PARK DR
SUITE 203
BRIDGEPORT, WV26330-9007
 Phone: 681-342-3190
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Plastic Surgery

208200000X 02 Physician/General Surgery
 

Surgery of the Hand

2082S0105X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for THOMAS J KENNEDY III · (Male)

NPI Number 1215033402
Status Active
Credentials MD
Entity Individual
Enumeration date 09/15/2006
Last updated 06/08/2011 - About 15 years ago
Sole proprietor 1 Yes
Identifiers
  • WV License # 20534
  • WV License # WV20534
  • WV Medicaid 3002519000
  • WV Other 001722749 BLUE CROSS/BLUE SHIELD
  • WV Other 350670000 FEDWORKER'S COMPENSATION
  • WV Other WV20534 HEALTH PLAN
  • WV Other 550781237 TAX ID
  • WV Other 1056649 WORKER'S COMP BRICK ST
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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