Provider Demographics
NPI:1033203518
Name:DR. KENNETH WILLIAMS PC
Entity Type:Organization
Organization Name:DR. KENNETH WILLIAMS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-548-2010
Mailing Address - Street 1:6101 LIMEKILN PIKE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-1432
Mailing Address - Country:US
Mailing Address - Phone:215-548-2010
Mailing Address - Fax:
Practice Address - Street 1:6101 LIMEKILN PIKE
Practice Address - Street 2:MEDICAL SUITE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-1432
Practice Address - Country:US
Practice Address - Phone:215-548-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008437L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016836460003Medicaid
PA019867Medicare ID - Type Unspecified