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General NPI Number Information
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NPI Number | 1457356818
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Entity Type | Organization
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Legal Business Name | TIMBER LANE ALLERGY & ASTHMA ASSOCIATES, PC
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 53 TIMBER LN
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-5201
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Country | US
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Telephone | 802-864-0294
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Fax | 802-864-3779
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Provider Business Mailing Address
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Address Line | 53 TIMBER LN
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-5201
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Country | US
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Telephone | 802-864-0294
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Fax | 802-864-3779
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD F KENT JR.
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Credential | MD
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Telephone | 802-864-0294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State | VT
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