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Individual

KENTON LANE DOVER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
20 YORK ST, NEW HAVEN, CT 06510-3220
(203) 688-4242
Mailing address
P.O. BOX 208057 300 CEDAR STREET TAC - 441 SOUTH, PULMONARY AND CRITICAL CARE SECTION, NEW HAVEN, CT 06520-8057
(203) 785-4162
(203) 785-3826

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2017-00171
NC
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
64852
CT
207RP1001X
Pulmonary Disease Physician
Primary
2017-00171
NC
207RP1001X
Pulmonary Disease Physician
64852
CT

Other

Enumeration date
05/06/2013
Last updated
12/07/2021
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