Basic Information
Provider Information
NPI: 1003294547
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FABIAN
FirstName: KENDRA
MiddleName:  
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Credential:  
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Mailing Information
Address1: PO BOX 191
Address2:  
City: ROCKLAND
State: DE
PostalCode: 197320191
CountryCode: US
TelephoneNumber: 3026514200
FaxNumber: 3026514945
Practice Location
Address1: 1600 ROCKLAND RD
Address2:  
City: WILMINGTON
State: DE
PostalCode: 19803
CountryCode: US
TelephoneNumber: 3026514200
FaxNumber: 3026514945
Other Information
ProviderEnumerationDate: 05/17/2015
LastUpdateDate: 02/06/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
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NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207PP0204XC1-0012766DEY Allopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
208000000X0116028464VAN Allopathic & Osteopathic PhysiciansPediatrics 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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