Provider Demographics
NPI:1376571067
Name:KINDER, ROY R JR (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:R
Last Name:KINDER
Suffix:JR
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 1:35 BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2504
Mailing Address - Country:US
Mailing Address - Phone:610-352-9021
Mailing Address - Fax:610-352-4015
Practice Address - Street 1:35 BRANDON RD
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2504
Practice Address - Country:US
Practice Address - Phone:610-352-9021
Practice Address - Fax:610-352-4015
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032726L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016071250001Medicaid
PA0016071250001Medicaid
PA098925Medicare PIN