Provider Demographics
NPI:1578563318
Name:KENT, WILLIAM DAVID (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVID
Last Name:KENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT THOMAS
Mailing Address - State:PA
Mailing Address - Zip Code:17252-9715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2257 MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:SAINT THOMAS
Practice Address - State:PA
Practice Address - Zip Code:17252-9715
Practice Address - Country:US
Practice Address - Phone:717-658-1519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019478E207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4603564OtherAETNA NON-HMO
PA831281OtherAETNA HMO
PAG920-0038/KDM4CUOtherCAREFIRST
PAMD019478EOtherPA LICENSE
PA25-1716306OtherINTERGROUP
PA87050OtherHIGHMARK BLUE SHIELD
PA1007307260034OtherMEDICAID GROUP #
PA122763OtherUNISON
1329775OtherFIRST HEALTH
PA25-1716306OtherMULTIPLAN/PHCS
PA0006163620003Medicaid
PA424178OtherHEALTH AMERICA
PA120420408OtherDEPT OF LABOR
PA25-1716306OtherDEVON
PA867633OtherMEDICARE GROUP #
PA080142010OtherRAILROAD MEDICARE
PA25-1716306OtherHEALTHNET/TRICARE
PA25-1716306OtherGREATWEST
PAP005049OtherGATEWAY
PA25-1716306OtherINFORMED
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA292258OtherMAMSI
PA50001095OtherCAPITAL BLUECROSS
PA50001095OtherCAPITAL BLUECROSS
PA867633OtherMEDICARE GROUP #
PAG920-0038/KDM4CUOtherCAREFIRST