Provider Demographics
NPI:1215049630
Name:DUNCAN, KATHYANN S (MD)
Entity type:Individual
Prefix:
First Name:KATHYANN
Middle Name:S
Last Name:DUNCAN
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 1:2040 MILLBURN AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3726
Mailing Address - Country:US
Mailing Address - Phone:973-762-4944
Mailing Address - Fax:973-762-4955
Practice Address - Street 1:3 FARRINGTON ST
Practice Address - Street 2:
Practice Address - City:VAUXHALL
Practice Address - State:NJ
Practice Address - Zip Code:07088-1307
Practice Address - Country:US
Practice Address - Phone:908-868-8904
Practice Address - Fax:973-762-4955
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06382900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7288301Medicaid
NJ953068Medicare ID - Type Unspecified
NJ7288301Medicaid