Healthcare Provider Details

I. General information

NPI: 1932581584
Provider Name (Legal Business Name): OLIVIA KENT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

4 FAIRWAY DR
CREAM RIDGE NJ
08514-1632
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-2332
  • Fax:
Mailing address:
  • Phone: 908-420-6613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT208827
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: