Provider Demographics
NPI:1467494096
Name:FLYNN-RODDEN, KARIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KARIN
Middle Name:
Last Name:FLYNN-RODDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148
Mailing Address - Country:US
Mailing Address - Phone:215-467-7360
Mailing Address - Fax:215-467-7318
Practice Address - Street 1:1629 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148
Practice Address - Country:US
Practice Address - Phone:215-467-7318
Practice Address - Fax:215-467-7318
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05399500207RA0201X
PAMD037839E207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ18348OtherAETNA
NJ2303818000OtherHMO KEYS
PA0423341000OtherKEYSTONE
PA047950OtherAETNA
PA047950OtherAETNA
NJ2303818000OtherHMO KEYS
NJ18348OtherAETNA