Healthcare Provider Details

I. General information

NPI: 1417956012
Provider Name (Legal Business Name): KEVIN K LENHART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 W MAIN ST STE 6
BRANFORD CT
06405-4047
US

IV. Provider business mailing address

251 W MAIN ST STE 6
BRANFORD CT
06405-4047
US

V. Phone/Fax

Practice location:
  • Phone: 203-315-5300
  • Fax: 203-315-5312
Mailing address:
  • Phone: 203-315-5300
  • Fax: 203-315-5312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number030100
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: