Provider Demographics
NPI:1538276068
Name:KENT, JEFFREY L (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:KENT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:LAURENCE
Other - Last Name:KENT
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:PO BOX 37189
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3189
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:46045 PALISADE PKWY
Practice Address - Street 2:
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-8761
Practice Address - Country:US
Practice Address - Phone:703-430-4343
Practice Address - Fax:571-313-8865
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46446207Q00000X
MI5101012007207Q00000X
VA0102206533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine