Provider Demographics
NPI:1033281977
Name:KENKARE, ZADIE (MD)
Entity type:Individual
Prefix:DR
First Name:ZADIE
Middle Name:
Last Name:KENKARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PEQUOT PARK RD 301
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498-2856
Mailing Address - Country:US
Mailing Address - Phone:860-399-6167
Mailing Address - Fax:860-399-6730
Practice Address - Street 1:8 E MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2058
Practice Address - Country:US
Practice Address - Phone:860-669-0719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040305207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH93201Medicare UPIN
CT110009016Medicare ID - Type Unspecified