Basic Information
| Provider Information | |||||||||
| NPI: | 1437376100 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KENT UROLOGY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 390 TOLL GATE RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028864326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017375253 | ||||||||
| FaxNumber: | 4017374606 | ||||||||
| Practice Location | |||||||||
| Address1: | 390 TOLL GATE RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028864326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017375253 | ||||||||
| FaxNumber: | 4017374606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DOBRZYNSKI | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4017375253 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 9000699 | 05 | RI | MEDICAID |