Active NPI
Kevin Patrick Fennelly, M.D.
- Pulmonary Disease Physician
- Bethesda, MD
National Provider Identifier
1255352597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- ME106064
- Practice address
- Nih Nhlbi Cardiovascular BR
10 Center Drive, BLDG 10, Room 6-3152
Bethesda, MD 20892-0001 - Phone
- (301) 827-0511
- Fax
- (301) 451-7093
- NPI assigned
- Jul 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | 25MA07311800 | NJ | |
| Preventive Medicine/Occupational Environmental Medicine Physician | 2083P0500X | 25MA07311800 | NJ | |
| Pulmonary Disease Physician | 207RP1001X | ME106064 | FL | Primary |
Addresses
Primary practice location
Nih Nhlbi Cardiovascular BR
10 Center Drive, BLDG 10, Room 6-3152
Bethesda, MD 20892-0001
Mailing address
Nih Nhlbi Cardiovascular BR
10 Center Drive, BLDG 10, Room 6-3152
Bethesda, MD 20892-0001
Phone (301) 827-0511
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5650607 | Medicaid | NJ | |
| 001760100 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME106064 | FL | MD | Pulmonary Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450224000000",
"number": "1255352597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "NIH NHLBI CARDIOVASCULAR BR",
"address_2": "10 CENTER DRIVE, BLDG 10, ROOM 6-3152",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208920001",
"telephone_number": "301-827-0511",
"fax_number": "301-451-7093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "NIH NHLBI CARDIOVASCULAR BR",
"address_2": "10 CENTER DRIVE, BLDG 10, ROOM 6-3152",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208920001",
"telephone_number": "301-827-0511",
"fax_number": "301-451-7093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENNELLY",
"first_name": "KEVIN",
"middle_name": "PATRICK",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-22",
"last_updated": "2015-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "NJ",
"license": "25MA07311800",
"primary": false
},
{
"code": "2083P0500X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
"state": "NJ",
"license": "25MA07311800",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "FL",
"license": "ME106064",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5650607",
"state": "NJ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001760100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethesda, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.