Provider Demographics
NPI:1053504787
Name:KUCHARCZUK, KRISTEN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KUCHARCZUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:LUKITOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:701 MONTGOMERY AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:PENN VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19072-2036
Practice Address - Country:US
Practice Address - Phone:610-642-9200
Practice Address - Fax:610-649-4723
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071340L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018743340001Medicaid
PAH57348Medicare UPIN