Provider Demographics
NPI:1629007109
Name:KENT, EDWARD ARMEN (MDD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ARMEN
Last Name:KENT
Suffix:
Gender:M
Credentials:MDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5568
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02880-5568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:77 FRANKLIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-3136
Practice Address - Country:US
Practice Address - Phone:401-596-2202
Practice Address - Fax:401-596-2202
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI08358207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI203430OtherBLUE CHIP BCBSRI
RI20154OtherBCBS OF RI
RI9020154Medicaid
F-36091Medicare UPIN