Provider Demographics
NPI:1962409029
Name:KENKRE, POORWA I (MD)
Entity type:Individual
Prefix:
First Name:POORWA
Middle Name:I
Last Name:KENKRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4512 KIRKWOOD HWY
Mailing Address - Street 2:STE 300
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5129
Mailing Address - Country:US
Mailing Address - Phone:302-992-9617
Mailing Address - Fax:302-992-9633
Practice Address - Street 1:4512 KIRKWOOD HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5123
Practice Address - Country:US
Practice Address - Phone:302-623-7500
Practice Address - Fax:302-623-7505
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006700208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000016557Medicaid
H71893Medicare UPIN
DE1000016557Medicaid