Donovan, Kenneth Wayne

Donovan, Kenneth Wayne is an individual health care provider with primary practice located at 365 Montauk Ave Room 4.512, New London CT 06320-4700. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Donovan, Kenneth Wayne can be contacted via phone (860) 442-0711.

Contact Information

Primary practice address
365 Montauk Ave Room 4.512 New London CT 06320-4700
Phone: (860) 442-0711
Fax: (860) 444-5114
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MD12478 Rhode Island
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 042916 Connecticut

Profile Details

NPI number 1669447207
LBN Legal business name Donovan, Kenneth Wayne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 17th, 2006
Last updated May 1st, 2024 - about 7 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669447207 NPPES
Connecticut MEDICAID 001429168

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