Healthcare Provider Details

I. General information

NPI: 1922480698
Provider Name (Legal Business Name): CHRISTOPHER E KENNEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 04/30/2024
Certification Date: 06/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 S GOVERNORS AVE
DOVER DE
19904-4107
US

IV. Provider business mailing address

640 S. STATE STREET MAIL CODE 3055
DOVER DE
19901
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-3752
  • Fax: 302-674-8521
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberDR.0067207
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC1-0024427
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: