Provider Demographics
NPI:1366449886
Name:RICHMAN, KENNETH ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALLEN
Last Name:RICHMAN
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 1:51 NORTH 39TH STREET
Mailing Address - Street 2:2ND FL. WRIGHT/SAUNDERS W223
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-8244
Mailing Address - Fax:215-545-1543
Practice Address - Street 1:51 NORTH 39TH STREET
Practice Address - Street 2:2ND FL. WRIGHT/SAUNDERS W223
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-662-8244
Practice Address - Fax:215-545-1543
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016633E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARI086184OtherPA BLUE SHIELD
PA0006293600002Medicaid
NJ2368706Medicaid
NJ2368706Medicaid
PA086184Medicare PIN