Healthcare Provider Details

I. General information

NPI: 1790969145
Provider Name (Legal Business Name): KENT PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 MAPLE ST
KENT CT
06757
US

IV. Provider business mailing address

PO BOX 885
KENT CT
06757-0885
US

V. Phone/Fax

Practice location:
  • Phone: 860-927-1133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number041413
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number041413
License Number StateCT

VIII. Authorized Official

Name: DR. SUZANNE M LEFEBVRE
Title or Position: OWNER
Credential: MD
Phone: 860-927-1133