Provider Demographics
NPI:1215952551
Name:KENT, RICHARD D (DPM)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:KENT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-1804
Mailing Address - Country:US
Mailing Address - Phone:540-459-3663
Mailing Address - Fax:540-459-2206
Practice Address - Street 1:641 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1804
Practice Address - Country:US
Practice Address - Phone:540-459-3663
Practice Address - Fax:540-459-2206
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001004213ES0131X, 213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9302743Medicaid
VA4022440001Medicare NSC
VAU67393Medicare UPIN