Provider Demographics
NPI:1104156488
Name:WILLIAMS, KEVIN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:WILLIAMS
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 1:5 GREENTREE CENTER
Mailing Address - Street 2:SUITE 117
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:561-421-5036
Mailing Address - Fax:561-421-5364
Practice Address - Street 1:5 GREENTREE CENTER
Practice Address - Street 2:SUITE 117
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:561-421-5036
Practice Address - Fax:561-421-5364
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY328118208D00000X
OK43785208D00000X
ND21369208D00000X
FLME169225208D00000X
NJ25MA07662800208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice