Provider Demographics
NPI:1447262498
Name:HOM, KENRICK E (MD)
Entity type:Individual
Prefix:DR
First Name:KENRICK
Middle Name:E
Last Name:HOM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4 FARM SPRINGS RD
Mailing Address - Street 2:PROHEALTH PHYSICIANS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2573
Mailing Address - Country:US
Mailing Address - Phone:860-284-5200
Mailing Address - Fax:860-284-5333
Practice Address - Street 1:538 LITCHFIELD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6669
Practice Address - Country:US
Practice Address - Phone:860-489-5148
Practice Address - Fax:860-489-4752
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-11-16
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Provider Licenses
StateLicense IDTaxonomies
CT020683207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB83409Medicare UPIN