Provider Demographics
NPI:1295797264
Name:SALLEE, KENT A (MD)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:A
Last Name:SALLEE
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 1:407 WREN LN
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2662
Mailing Address - Country:US
Mailing Address - Phone:302-757-3342
Mailing Address - Fax:610-444-6055
Practice Address - Street 1:4031 KENNETT PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-2047
Practice Address - Country:US
Practice Address - Phone:302-757-3342
Practice Address - Fax:610-444-6055
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0001606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000187601Medicaid
DEB66294Medicare UPIN
DE0000187601Medicaid