Provider Demographics
NPI:1508816075
Name:FLEMING, KEVIN MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MARTIN
Last Name:FLEMING
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 1:710 STATION AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035
Mailing Address - Country:US
Mailing Address - Phone:856-547-7126
Mailing Address - Fax:856-547-4669
Practice Address - Street 1:710 STATION AVE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035
Practice Address - Country:US
Practice Address - Phone:856-547-7126
Practice Address - Fax:856-547-4669
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C54749Medicare UPIN
445225Medicare ID - Type Unspecified