Provider Demographics
NPI:1417969908
Name:DUCKWORTH, KAREN MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MELISSA
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:500 S BROAD ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1613
Mailing Address - Country:US
Mailing Address - Phone:215-685-6769
Mailing Address - Fax:215-685-6732
Practice Address - Street 1:131 E CHELTEN AVE
Practice Address - Street 2:HEALTH CARE CENTER #9
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2153
Practice Address - Country:US
Practice Address - Phone:215-685-5701
Practice Address - Fax:215-685-5748
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD072825L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019082630001Medicaid
PADU1402282Medicare ID - Type Unspecified
PA0019082630001Medicaid