Provider Demographics
NPI:1124023577
Name:KENT, EDWARD F JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:F
Last Name:KENT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:53 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-5201
Mailing Address - Country:US
Mailing Address - Phone:802-864-0294
Mailing Address - Fax:802-864-3779
Practice Address - Street 1:53 TIMBER LN
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-5201
Practice Address - Country:US
Practice Address - Phone:802-864-0294
Practice Address - Fax:802-864-3779
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01140418Medicaid
NY30F541OtherBCBS NORTHEAST NY
VT3V002OtherMVP
VT0055573-001OtherCIGNA
VT0009448Medicaid
VT9969OtherBLUE CROSS BLUE SHIELD VT
E13692Medicare UPIN
VT3V002OtherMVP