Healthcare Provider Details

I. General information

NPI: 1417044298
Provider Name (Legal Business Name): KENT DIAGNOSTIC RADIOLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST
DOVER DE
19901-3530
US

IV. Provider business mailing address

PO BOX 4238
PORTSMOUTH NH
03802-4238
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-2202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL STILES
Title or Position: PROVIDER
Credential:
Phone: 302-744-6122