Provider Demographics
NPI:1851456891
Name:KANE, DENNIS RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RICHARD
Last Name:KANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 CANAL ST STE 500
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-6017
Mailing Address - Country:US
Mailing Address - Phone:912-748-4527
Mailing Address - Fax:912-748-9016
Practice Address - Street 1:143 CANAL ST STE 500
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-6017
Practice Address - Country:US
Practice Address - Phone:912-748-4527
Practice Address - Fax:912-748-9016
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048427208000000X
DCMD30330208000000X
MDD0051613208000000X
GA88922208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F51465Medicare UPIN