Provider Demographics
NPI:1982917928
Name:KENDLE, ELLIS MAWAGA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIS
Middle Name:MAWAGA
Last Name:KENDLE
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 1:119 FALCON LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1937
Mailing Address - Country:US
Mailing Address - Phone:302-235-8581
Mailing Address - Fax:
Practice Address - Street 1:119 FALCON LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1937
Practice Address - Country:US
Practice Address - Phone:302-235-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE10000441207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine