Provider Demographics
NPI:1528068848
Name:KENT, CAROLYN DAVIS (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DAVIS
Last Name:KENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:22 ST PAUL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1033
Mailing Address - Country:US
Mailing Address - Phone:717-709-7922
Mailing Address - Fax:717-263-2055
Practice Address - Street 1:830 5TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4219
Practice Address - Country:US
Practice Address - Phone:717-263-0550
Practice Address - Fax:717-263-8898
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2017-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD020437E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000624490Medicaid
G-10977Medicare UPIN
PA140827KQCMedicare ID - Type Unspecified