Provider Demographics
NPI:1356357149
Name:FENNESSY, THOMAS N (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:N
Last Name:FENNESSY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2900 MIMICK DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3350
Mailing Address - Country:US
Mailing Address - Phone:402-992-0659
Mailing Address - Fax:402-625-0005
Practice Address - Street 1:2501 LAKERIDGE DR STE 104
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2558
Practice Address - Country:US
Practice Address - Phone:402-368-9964
Practice Address - Fax:402-368-5675
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA34333207Q00000X
NE22583207Q00000X
SD5291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01724OtherBCBS
NEH60069Medicare UPIN