Provider Demographics
NPI:1417050576
Name:KENDALL, DOROTHY F (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:F
Last Name:KENDALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DOROTHY
Other - Middle Name:W
Other - Last Name:FOWLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:910 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2124
Mailing Address - Country:US
Mailing Address - Phone:803-534-2328
Mailing Address - Fax:803-531-8419
Practice Address - Street 1:910 COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2124
Practice Address - Country:US
Practice Address - Phone:803-534-2328
Practice Address - Fax:803-531-8419
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC144842084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC570609170OtherFACILITY IRS TAXPAYER ID NUMBER