Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2017-00171 | NC |
N | 111NI0900X | Internist | 2017-00171 | NC |
N | 207RC0200X | Critical Care Medicine | 64852 | CT |
Y | 207RP1001X | Pulmonary Disease | 2017-00171 | NC |
N | 207RP1001X | Pulmonary Disease | 64852 | CT |
NPI | 1063857902 |
---|---|
Provider Name | Kenton Lane Dover |
First Address | New Haven, CT 06520-8057 |
Second Address | New Haven, CT 06510-3220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2013 |
Last Update Date | 07/12/2021 |