Provider Demographics
NPI:1730778937
Name:KENT A SALLEE, MD LLC
Entity type:Organization
Organization Name:KENT A SALLEE, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALLEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-757-3342
Mailing Address - Street 1:PO BOX 5110
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-0110
Mailing Address - Country:US
Mailing Address - Phone:302-633-5840
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty